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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.

     

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