期刊名称：Journal of Minimally Invasive Surgical Sciences
印刷版ISSN：2251-7022
电子版ISSN：2251-7030
出版年度：2012
卷号：1
期号：1
页码：11-16
DOI：10.5812/jmiss.1793
出版社：Kowsar
摘要：Background: Total and partial gastrectomy is commonly used to treat gastric carcinoma or other benign or malignant conditions of the stomach. Laparoscopic-assisted distal gastrectomy is an alternative approach for treating mucosal gastric cancer. Many investigators have assessed the safety, efficacy, and feasibility of this procedure. Objectives: The aim of present study is to compare the outcomes obtained using Roux-en-Y and Jejunal Loop Interposition reconstructive techniques after laparoscopic-assisted distal gastrectomy and determine the gross pathologic and histological changes in the anastomotic area and the macroscopic and microscopic pancreatic changes 1 and 3 months after the surgery. Materials and Methods: Twelve adult healthy male mixed-breed dogs were divided randomly into 2 groups of 6 animals each. In group A, left gastroepiploic vessel and its branches, gastroepiploic ligament, and right gastroepiploic vessels were ligated and resected laparoscopically. A loop of jejunum, 20 cm distal to the Treitz ligament, was resected and end-to-side anastomosis was performed between the distal jejunal end and remaining part of the stomach. The proximal jejunal end was end-to-side anastomosed to the rest of the jejunum. In group B, gastrectomy was performed in the same manner. A 20-cm jejunal loop, 20 cm from the Treitz ligament, was resected, and the remaining part of the stomach and jejunum was anastomosed. Jejunojejunostomy was performed between the two remaining jejunal parts. Results: Esophagoscopy showed no en bloc resection of the esophagus or alkaline gastritis. A 2-cm by 2-cm ulcerative mass was observed in the remaining part of the stomach close to gastrojejunal anastomotic site in one patient of group A. The animals were authanized one and three month after the surgery. Macroscopic evaluation revealed normal healing of the incisional scars without any inflammation, abscess, adhesion, or other acute or chronic inflammatory reactions. Microscopic evaluation of the pancreatic sections revealed normal appearance of the gland structure, Langerhans islets, and ductal systems without any inflammatory reaction. Decrease in the number of zymogen granules was noted in most of the cases. The junction between the esophagus and stomach was normal in all the cases, and no inflammatory, degenerative, proliferative, hypoplastic, necrotic, hemorrhagic, edemic, and ulcerative changes were noted. There were no pathologic abnormalities in any of the esophagogastric junction sections. In the gastrojejunal anastomotic sites, decreased stomach thickness at the anastomotic site and cystic dilatation of the jejunal crypts was noted. Conclusions: Upper gastrointestinal endoscopy was found to be a useful and feasible technique to detect esophageal gastritis; anatomical structure, obstruction, or stenosis; and other disorders of the upper gastrointestinal tract. In addition, the 2 reconstructive techniques used following gastrectomy yielded similar endoscopic and pathologic findings.
