Beneficial Effects Of Functional Jejunal Interposition Procedure After Total Gastrectomy On Beagles

Objective:We investigated the mechanisms by which a reconstruction procedure after total gastrectomy, functional jejunal interposition (FJI), exerts beneficial effects.Summary of background data:We have developed FJI for patients with total gastrectomy. FJI maintains jejunal continuity and duodenal food transit. Clinical studies have showed that this procedure reduces complications and improves nutritional status in patients with gastric cancer after total gastrectomy. Methods:FJI, Roux-en-Y, and sham operation were performed after total gastrectomy on beagles by the same surgeon. Beagles were sacrificed 48 hours postoperatively and tissues from the duodenojejunal anastomosis were collected for determining inflammation, apoptosis, and interstitial cells of Cajal (ICC) by immunostaining. Sera were collected before and after operation for detecting intestinal hormone levels using ELISA.Results:Sham group surgical time was 66.67±11.55 min; RY group 243.33±32.15 min; FJI group 262.86±34.02 min. Surgical group time is more than sham,there was no difference betwent RY group and FJI group.Gastrointestinal transmit ratio of FJIs' 0.32±0.11 campared 0.52±0.21 of RY group(P<0.05). More ICC were found in submuocsa of beagles with FJI than those in Roux-en-Y group, which suggests that FJI leads to less loss of intestinal motility. Inflammation in serosal side of the intestine, including hemorrhage, fibrin deposition, and ulceration, neutrophil and macrophage infiltration, and intestinal epithelial cell apoptosis were significant reduced in beagles receiving FJI, compared to those in Roux-en-Y group. WBC count as 10.77±3.00×109/L before surgery; WBC count of sham group was 8.30±13.41×109/L post surgery, RY group was 21.75±7.45×109/L, FJI group was 8.99±3.21×109/L, there were no difference among them (P>0.05). HGB was 165.33±12.15g/L before surgery; sham group was 180.67±28.88 g/L, RY group was 142.33±14.88 g/L, FJI group was 145.03± mmol/L,4.28±0.29mmol/L, respectively; Fe2+ 8.45±0.25μmol/L and 5.26±3.63μmol/L, respectively; which were low level compared with sham group K+ 4.70±0.41 mmol/L,Fe2+ 11.57±4.44μmol/L. In serum Cho, Glu, TP, Alb, ALP, TBIL, CRE, BUN, Na+, K+, Cl were no difference. IL6 and TNF were no identified, IL1 was 98.59±71.47pg/ml before surgery; IL1 was 68.84±30.84 pg/ml in sham group, 67.12±8.17 pg/ml in RY group,63.50±42.0 pg/ml in FJI group; IL6 was 0 pg/ml in sham group,10.59±18.34 pg/ml in RY group,19.48±49.06 pg/ml in FJI group, TNF was 374.62±28.5 pg/ml in sham,372.65±19.58 pg/ml in RY group,370.84±171.6 pg/ml in FJI group. There were no difference among them (P>0.05). Post surgery, IgG was 1.79±0.63 g/l in sham,1.33±0.10 g/l RY group,2.14±0.67 g/l in FJI group; IgA was 0.254±0.01 g/l in sham,0.266+0.02 g/l RY group,0.26±0.01 g/l in FJI group. IgM was 0.42±0.17 g/l in sham,0.43±0.34 g/l RY group,0.46±0.20 g/1 in FJI group. There were no difference among them (P>0.05). Furthermore, the level of somatostantin in sera after surgery in FJI group was higher than that in sham and Roux-en-Y groups,62.41±13.38ng/ml vs 40.13±5.51 ng/ml and 39.75±3.75ng/ml (P<0.05), which may contribute to food storage and recovering of gastrointestinal function after operation.Conclusions:Improvement of the outcomes after gastrectomy by FJI may be through preserving intestinal functional motility, ameliorating intestinal inflammation, and facilitating the intestinal endocrine function.