"Ulm pouch" technique for total gastrectomy. Chinese experiences.

AIM: Ulm jejunal interposition reconstruction for total gastrectomy was applied in 62 patients in China, and its morphology was observed by virtual endoscopy. METHODS: The study enrolled 220 patients who underwent total gastrectomy. Among them 62 underwent Ulm reconstruction. Patients were 34 men and 28 women, with a mean age of 56 years (range 23-79). Twenty-two patients had underlying diseases, including hypertension and coronary disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and malnutrition. An Ulm was made from a jejunal segment by using staplers. An esophago-jejuno anastomosis and an end-to-end anastomosis of the distal end of the pouch to the duodenum were also performed by hand sutures or a stapler. The dimensions of the Ulm were measured in 10 randomly selected patients, and we observed the pouch's morphology by virtual endoscopy in 13 patients. We performed Roux-Y reconstruction for the remaining patients. Fifty patients received adjuvant chemotherapy and all patients were followed for one to two years postoperatively. RESULTS: All operations were successful. Ulm in size and shape were similarly like actual stomach. Patients regained their appetite within three days of the operation. At one- to two-month postoperative follow-up, patients' nutritional condition had improved and they gained 2-5 kg of body weights. Complications included postoperative cholecystitis, jejuno-duodenal anastomosis leakage and upper gastric bleeding. CONCLUSION: Ulm for total gastrectomy is a safe procedure for alimentary reconstruction. The use of linear and circular staplers simplifies the procedure and reduces operative time. Virtual endoscopy showed that the morphology of the pouch is similar to the native stomach. Ulm reconstruction results in a good postoperative quality of life and favorable prognosis.