Comparative Endoscopic Evaluation of Reconstructive Roux-en-Y With Jejunal Loop Interposition Following Gastrectomy in Dogs

Abstract

Objective- Comparative endoscopic evaluation of two reconstructive methods (R&Y and jejunal loop interposition) after gastrectomy in dogs. Design- Experimental study. Animals- Ten healthy male dogs. Procedures- The animals were divided randomly in two groups. After a 12 hour food withhold and under general anesthesia laparotomy is performed in all dogs. In group A (R&Y), after dissection and resection of all gastric vessels and ligaments, the stomach was resected cranially close to cardia and caudally close to pylorus. After gastrectomy duodenal end was closed in a two layer inverting suture pattern. Then a loop of jejunum 20 cm distal to Treitz ligament was identified and resected. End to side anastomosis was performed between the distal jejunal end and remained part of the stomach. The proximal jejunal end was end to side anastomosed to the rest of jejunum. In group B (JLI), gastrectomy was done in the same manner. The 20 cm length of jejunum was resected from a 20 cm distance to Treitz ligament. The proximal end of the jejunal loop was end to side anastomosed to the remained part of the stomach and the distal end was anastomosed to the proximal jejunum. Finally jejunojejunostomy was performed between the two Jejunal parts. 1 month after surgery, esophagoscopic and gastroscopic evaluation was performed to rule out the reflux esophagitis or gastritis. Results- Esophagoscopy and gastroscopy thirty days after operation revealed normal appearance at gastroduodenal and duodenojejunal anastomotic junctions. There was no report of enterogastric biliary reflux (EBR) in esophagus or alkaline gastritis. A 2 cm to 2 cm ulcerative mass was observed in the remained part of stomach close to gastrojejunal anastomotic site in one patient in group A. Also regurgitation was noticed in the same patient. A 1 cm to 1 cm ulcer was reported in one patient in group B. Morphology of all anastomotic sites was normal. They were all patent and healed normally without any signs of inflammation. Conclusion and Clinical Relevance- The results of this study showed that the JLI like R&Y technique is a successful method to prevent reflux esophagitis.