IN THE operation of total gastrectomy, replacement of the stomach with the terminal ileum and right colon appears to offer several advantages: (1) the ileocecal valve prevents regurgitation into the esophagus; (2) the transplaced right colon will accept an average-sized meal; (3) there are no apparent sensitivities of the right colon to ingested food, and (4) interposing the ileocolon between the esophagus and the duodenum with the resultant admixture of mucus to ingested food prevents or decreases adverse effects on the jejunum.
After it is determined that total gastrectomy is indicated and feasible, the terminal ileum and right colon are mobilized as if a right colon resection were contemplated. The terminal ileum is transected about 4 in. (10 cm.) from the ileocecal junction. The right colon is transected at or near the hepatic flexure, depending upon the variable right colic artery1 (Fig. 1).
The mesentery of the right colon