Rétablissement de continuité après gastrectomie : quelle technique ?

Different techniques of reconstruction are offered after gastrectomy. The preferred reconstruction should allow maintaining nutritional status and quality of life of patients at the price of the lowest postoperative morbidity. The aim of this study was to describe the different techniques of reconstruction after distal and total gastrectomy, reminding the French guidelines on the use of mechanical sutures in these indications. We then conducted a review of randomized trials dealing with techniques of reconstruction after distal and total gastrectomy. After distal gastrectomy, Roux-en-Y reconstruction seems superior to Billroth I and Billroth II reconstruction in terms of functional outcomes and long-term endoscopic results and should be chosen in patients with benign disease or surperficial tumours. Otherwise, Billroth II reconstruction should be preferred to Billroth I reconstruction for preventing postoperative morbidity and in order to preserve oncological margins. After total gastrectomy, Roux-en-Y reconstruction remains the easiest solution, with satisfactory functional results. Addition of a pouch reservoir after Roux-en-Y reconstruction seems to improve functional short-term results after total gastrectomy with greater intake. In the long-term, it could be beneficial from the quality of life standpoint mainly in cases of small resected tumours associated with a good prognosis.