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At least 289 records · Page 16Linked to original sources
PubMed1999

Quality of life after laparoscopy-assisted Billroth I gastrectomy.

OBJECTIVE: To evaluate the quality of life of patients who had undergone laparoscopy-assisted Billroth I gastrectomy (LAG) for cure of cancer. SUMMARY BACKGROUND DATA: In 1994, the authors reported the first case of LAG for early gastric cancer, and this approach quickly has been adopted by Japanese surgeons. However, little is known about the subjective clinical results of this less invasive surgery. METHODS: Quality of life was estimated using the 24-item questionnaire with a scoring system of 1, 2, and 3 and was compared between 41 consecutive patients with LAG and 35 with conventional open gastrectomy. All patients underwent Billroth I gastrectomy for early gastric cancer from January 1993 to July 1997 and were alive without recurrence. RESULTS: Patients who had undergone LAG were taking a normal diet (100%) with >66% of volume at each meal (90%), showed no decreased performance status (90%), and were satisfied with their surgical results (88%). Patients with LAG, when compared with open gastrectomy, showed significantly better results with regard to weight loss, difficulty in swallowing, heartburn and belch, early dumping syndrome, and total score. LAG was better accepted by the patients. CONCLUSIONS: Quality of life after Billroth I gastrectomy was significantly better in patients in whom a laparoscopic technique was used than in those who underwent a conventional method. LAG is less invasive and better accepted by patients and is the procedure of choice for the treatment of early gastric cancer.

Aged↗
PubMed2002

Total gastrectomy severely alters the central regulation of food intake in rats.

OBJECTIVE: To investigate the central regulation of food intake by quantifying neuron activation of the nucleus of the solitary tract (NTS) after injection of cholecystokinin (CCK) or food intake in gastrectomized rats. SUMMARY BACKGROUND DATA: Total gastrectomy is followed by early satiety, low calorie intake, and weight loss in the majority of patients. The etiology of these effects is unknown. Sixty percent to 70% of patients remain underweight after total gastrectomy, the weight loss averaging 25% of preoperative body weight. About two thirds of gastrectomized patients report early satiety, and about 60% do not reach the recommended daily calorie intake. The NTS is a brain stem center involved in the regulation of food intake; thus, the extent and pattern of neuronal activation provide information on the process involved in the initiation of satiation and the regulation of food intake. METHODS: The authors investigated neuronal activation in the NTS using c-fos immunohistochemistry following CCK injection or food intake in healthy control rats, sham-operated control rats, age-matched control rats, weight-matched control rats, and vagotomized or gastrectomized rats. RESULTS: Neuronal activation in the NTS after CCK injection was significantly decreased 21 days after total gastrectomy, but increased by up to 51% 3 months and by up to 102% 12 months after surgery compared to age-matched unoperated control rats. Neuronal activation in the NTS in response to feeding was markedly increased up to fivefold in gastrectomized rats. This increase was early in onset and sustained, and occurred despite significantly reduced food intake. Administration of MK329, a CCK-A receptor antagonist, significantly reduced the number of postprandially activated neurons in both gastrectomized and control rats. CONCLUSIONS: The early postprandial activation of NTS neurons after total gastrectomy in rats may correspond to early satiety reported by patients, while the sustained activation of NTS neurons after a meal could contribute to a reduced daily calorie intake. These data suggest that a disturbed central regulation of food intake might contribute to early satiety, reduced food intake, and weight loss after total gastrectomy.

Animals↗
PubMed2006

Postprandial gastrointestinal hormone production is different, depending on the type of reconstruction following total gastrectomy.

OBJECTIVES: The present study examines the differences in gastrointestinal hormone production at 3 different reconstruction types after total gastrectomy. BACKGROUND DATA: Total gastrectomy causes significant weight loss, mainly due to a reduced caloric intake probably because of a lack of initiative to eat or early satiety during meals. Behind this phenomenon a disturbed gastrointestinal hormone production can be presumed. METHODS: Patients participating in a randomized study were recruited for the clinical experiment. Seven patients with simple Roux-en-Y reconstruction, 11 with aboral pouch (AP) construction, and 10 with aboral pouch with preserved duodenal passage (APwPDP) reconstruction, as well as 6 healthy volunteers were examined. Blood samples were taken 5 minutes before and 15, 30, and 60 minutes after ingestion of a liquid test meal. Plasma concentrations for insulin, cholecystokinin, and somatostatin were determined by radioimmunoassay analysis. RESULTS: Postprandial hyperglycemia was observed in patients after total gastrectomy most prominently in groups with duodenal exclusion (Roux-en-Y and AP) compared with healthy controls. Postprandial insulin curves reached significantly higher levels in all operated groups compared with controls, however, with no difference according to reconstruction type. Significantly higher cholecystokinin levels and higher integrated production of cholecystokinin were observed in Roux-en-Y and AP groups compared with APwPDP and control. Postprandial somatostatin levels were significantly different between the 4 groups, and highest levels and integrated secretions were reached in AP group, lowest in APwPDP and normal groups. CONCLUSION: A disturbed glucose homeostasis was observed in gastrectomized patients most prominently in the Roux-en-Y group. Also, cholecystokinin and somatostatin response differed significantly in favor of duodenal passage preservation after total gastrectomy. Cholecystokinin levels close to physiologic found at APwPDP reconstruction may contribute to a physiologic satiation in reconstructions with preserved duodenal passage after total gastrectomy.

Anastomosis, Roux-en-Y↗
PubMed2007

A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan.

BACKGROUND: Laparoscopic surgery for gastric cancer is technically feasible, but it is not widely accepted because it has not been evaluated from the standpoint of oncologic outcome. We conducted a retrospective, multicenter study of a large series of patients in Japan to evaluate the short- and long-term outcomes of laparoscopic gastrectomy for early gastric cancer (EGC). METHODS: The study group comprised 1294 patients who underwent laparoscopic gastrectomy during the period April 1994 through December 2003 in 16 participating surgical units (Japanese Laparoscopic Surgery Study Group). The short- and long-term outcomes of these patients were examined. RESULTS: Distal gastrectomy was performed in 1185 patients (91.5%), proximal gastrectomy in 54 (4.2%), and total gastrectomy in 55 (4.3%); all were performed laparoscopically. The morbidity and mortality rates associated with these operations were 14.8% and 0%, respectively. Histologically, 1212 patients (93.7%) had stage IA disease, 75 (5.8%) had stage IB disease, and 7 (0.5%) had stage II disease (the UICC staging). Cancer recurred in only 6 (0.6%) of 1294 patients treated curatively (median follow-up, 36 months; range, 13-113 months). The 5-year disease-free survival rate was 99.8% for stage IA disease, 98.7% for stage IB disease, and 85.7% for stage II disease. CONCLUSIONS: Although our findings may be considered preliminary, our data indicate that laparoscopic surgery for EGC yields good short- and long-term oncologic outcomes.

Adenocarcinoma↗
PubMed1998

Gastroesophageal reflux after distal gastrectomy: possible significance of the angle of His.

OBJECTIVE: We investigated whether the angle of His influences gastroesophageal reflux after distal gastrectomy. METHODS: Thirty-eight patients having distal gastrectomy and 10 controls underwent upper gastroesophageal fluoroscopy to measure the angle of His, and gastroesophageal reflux was assessed by scintigraphy. The association between scintigraphic reflux and the angle of His was then evaluated. RESULTS: In distal gastrectomy patients with and without reflux symptoms, the angle was 108.82 +/- 21.88 degrees and 96.07 +/- 13.25 degrees, respectively; it was 74.14 +/- 10.85 degrees in the controls. The angle was significantly larger in the patients than in the controls (p < 0.01). In addition, the angle in the symptomatic gastrectomy group tended to be larger than in the asymptomatic group. The angle was also significantly larger in patients with a scintigraphic reflux index > or =6% than in those with an index <6% (p < 0.05). CONCLUSIONS: These findings suggest that the angle of His plays a role in reflux after distal gastrectomy and that the severity of reflux may be estimated by measuring this angle.

Adult↗
PubMed2005

D2 gastrectomy -- a safe operation in experienced hands.

In the contemporary practice, surgery is the only potentially curative treatment available for gastric cancer. However, there is no consensus on the extent of surgical resection. Advantages of D2 gastrectomy in terms of morbidity, mortality, local recurrence and survival are confirmed in Japanese as well as some European trials. In our hospital, all patients with operable gastric cancer are treated with D2 gastrectomy along with splenectomy and distal pancreatectomy followed by jejunal pouch reconstruction. The study was undertaken to evaluate our practice in terms of postoperative morbidity and mortality. All the patients who had total gastrectomy for gastric carcinoma from January 1995 to December 2000 were included in the study. During this 6-year period, 33 patients underwent potentially curative D2 gastrectomy. Postoperative morbidity and mortality were 18 and 9%, respectively. There were no anastomotic leaks. Three (9%) patients developed dysphasia, of which two (6%) had anastomotic stricture requiring dilatation. We feel D2 gastrectomy with splenectomy and distal pancreatectomy when performed electively is a safe procedure in experienced hands. Oesophago-jejunal anastomosis can be safely performed using circular stapler.

Aged↗
PubMed1994

Gastrectomy and subsequent risk of oesophageal cancer in Milan.

STUDY OBJECTIVE: To analyse quantitatively the relationship between gastrectomy and oesophageal cancer risk. DESIGN: This was a case-control study, based on a structured questionnaire that included a problem-oriented medical history. SETTING: A network of hospitals in the Greater Milan area between 1984 and 1992. SUBJECTS: Subjects were 316 incident, histologically confirmed cases of oesophageal cancer (258 males and 58 females), and 1408 controls (1031 males, 377 females), admitted to hospital for acute, non-neoplastic, non-digestive tract conditions. MEASUREMENTS AND MAIN RESULTS: Relative risks (RR) and the corresponding 95% confidence intervals (CI) adjusted for age and sex, plus area of residence, education, tobacco, and alcohol consumption. There was an association of borderline significance of oesophageal cancer with gastric ulcer (RR = 1.6), but not with duodenal ulcer (RR = 0.9). Among cases, 25 (7.9%) reported a history of gastrectomy, versus 29 (2.1%) of the controls. The corresponding multivariate RR was 3.8 (95% CI 2.0, 7.0). The RR of oesophageal cancer was significantly raised (RR = 3.6) within 20 years after gastrectomy, and the association seemed stronger with increasing time since gastrectomy (RR = 4.2). CONCLUSIONS: Since gastrectomy may cause gastric hypoacidity and favour oesophageal reflux, and hence oesophagitis, the results of this study, if confirmed, are of interest to a better understanding of the mechanisms of oesophageal carcinogenesis.

Adult↗
PubMed1990

A gastrectomy population: 25-30 years on.

Prior to 1960 a Polya gastrectomy was the most frequent operation for duodenal ulcer. The majority of these patients now have reached the age of sixty or older. A prospective longitudinal study of a cohort of patients who underwent gastrectomy between 1955 and 1960 was undertaken. Twenty five to thirty years later the study has revealed the extent of the nutritional problems that may arise with the passage of time and shows that these numerically far outweigh the mechanical post-gastrectomy syndromes and weight loss which tended to dominate the earlier post-gastrectomy scene. By the end of the first decade, iron deficiency was the commonest nutritional problem. Vitamin B12 deficiency assumed more importance in the second decade. During the third decade both reached equal prevalence, being found in some 90% of the female and 70% of the male residual population. Vitamin D deficiency and early osteomalacia was a lesser problem, reaching its climax in the second decade. Evidence suggested a high incidence of osteoporosis and this requires further investigation. Overall, women fared worse than men with a higher and earlier incidence of iron deficiency, particularly in the pre-menopausal group. This study emphasizes the increasing need for regular screening of post-gastrectomy patients to detect early iron, vitamin B12 and vitamin D deficiencies as patients grow older.

Celiac Disease↗
PubMed2003

Preoperative administration of rebamipide significantly lowers body temperature and circulating interleukin-6 in gastric cancer patients after gastrectomy.

BACKGROUND/AIMS: It has recently been reported that rebamipide (OPC-12759) inhibits inflammatory cytokines and activation of neutrophils. The aim of the present study was to investigate the effects of preoperative administration of rebamipide on parameters of systemic inflammatory response syndrome (SIRS) and serum levels of inflammatory cytokines in gastric cancer patients after gastrectomy. PATIENTS AND METHODS: We measured the parameters of SIRS, circulating cytokines and acute phase reactants in patients after (i). distal gastrectomy with D2 lymph node dissection (group 1, n = 10); (ii). distal gastrectomy with D2 lymph node dissection following administration of rebamipide (group 2, n = 10), and (iii). laparoscopy-assisted distal gastrectomy (LADG) with D1 lymph node dissection (group 3, n = 10). Group 2 was administered 100 mg of rebamipide 3 times/day after meals for 7 days before surgery. RESULTS: Among the parameters of SIRS, a difference was observed in body temperature on day 3. The mean body temperature of group 2 was significantly lower than group 1 (p = 0.006), and was similar to group 3. In proinflammatory cytokines, a significant difference was observed in the serum levels of interleukin (IL)-6. On day 1 the IL-6 levels of group 2 were significantly lower than those of group 1 (p < 0.001). The changes in the IL-6 level of group 2 were similar to group 3, except in the very early postoperative phase. However, other proinflammatory cytokines, such as IL-8 and IL-10, were not detected, and there was no difference in C-reactive protein between the 3 groups. CONCLUSION: Preoperative administration of rebamipide significantly decreased postoperative body temperatures and circulating IL-6 in gastric cancer patients after gastrectomy to levels similar to those of patients with LADG.

Aged↗
PubMed1989

Prospective study of the effect of gastrectomy with and without bile reflux on serum pepsinogens.

In order to prospectively determine the effect of gastrectomy with or without enterogastric reflux on serum pepsinogen concentrations, serum pepsinogen A, serum pepsinogen C and the pepsinogen A:C ratio were measured before, and 10 days and 6, 15 and 24 months after 2/3-3/4 distal gastrectomy in peptic ulcer patients with primary Roux-en-Y diversion (n = 11) or Billroth II reconstruction (n = 11). Gastrectomy induced early decreases in serum pepsinogen A from 100 +/- 12 to 66 +/- 7 micrograms/l (p less than 0.05) and from 111 +/- 11 to 82 +/- 20 micrograms/l (p = 0.05), serum pepsinogen C from 49 +/- 6 to 29 +/- 5 micrograms/l (p less than 0.05) and from 54 +/- 9 to 40 +/- 11 micrograms/l (p = 0.10) in patients with Roux-en-Y and Billroth II gastrectomy, respectively, but did not influence the pepsinogen A:C ratios. Serum pepsinogen A and the pepsinogen A:C ratio continued to decrease 6 months after surgery but no further significant reductions were observed 15 and 24 months postoperatively. Serum pepsinogen C concentrations did not significantly change during postoperative follow-up. Analyses of variances of serum pepsinogen A and the pepsinogen A:C ratio showed that the type of operation had no significant effect on the postoperative course. It is concluded that gastrectomy leads to early decreases in serum pepsinogen A and pepsinogen C levels followed by progressive further reductions of serum pepsinogen A and the pepsinogen A:C ratio for a period of 6 months postoperatively. These postoperative changes of serum pepsinogens are not due to increased enterogastric biliary reflux.

Atrophy↗
PubMedDate not supplied

Branched-chain amino acids metabolic support in surgical patients: a randomized, controlled trial in patients with subtotal or total gastrectomy in 16 Japanese institutions.

A prospective, randomized, controlled trial of nutritional effects of branched-chain-enriched amino acid (BCAA) solution was undertaken in 173 surgical patients with gastric cancer. Eighty-six and 87 patients underwent subtotal and total gastrectomy, respectively. The effects were evaluated in total parenteral nutrition (TPN) in an isocaloric/isonitrogenous setting where the major difference between the group was the amount of BCAA received. Each 80 patients in the control and the BCAA groups completed the trial. The group receiving BCAA-enriched amino acid solution demonstrated a statistically significant improvement on days 2 and 3 in nitrogen balance in patients with total gastrectomy. Three-methyl-histidine excretion gradually decreased after day 1, and the values on day 7 were significantly lower than those on day 1 in the BCAA group in both those receiving subtotal and total gastrectomy. There were no significant differences of serum albumin and rapid turnover proteins between the control and BCAA groups in both those receiving subtotal and total gastrectomy. Plasma BCAA level and BCAA to aromatic amino acid (AAA) ratio were significantly higher, and AAA level was significantly lower in the BCAA group than in the control group. There were no serious complications encountered during the observation period in both groups. These results indicated that a BCAA-enriched amino acid solution can improve metabolism and maintains good nitrogen retention without increasing side effects as compared with a conventional amino acid solution for nutritional support of patients who have received subtotal or total gastrectomy.

Adolescent↗
PubMed1998

Morbidity and mortality after D2 gastrectomy for gastric cancer: results of the Italian Gastric Cancer Study Group prospective multicenter surgical study.

PURPOSE: To investigate whether pancreas preservation together with a strict quality-control system could ameliorate the outcome of D2 resections for gastric cancer in Western patients. PATIENTS AND METHODS: Italian patients with potentially curable proven adenocarcinoma of the stomach were registered from nine general and/or university hospitals in the area of Turin, Northern Italy. The study was performed according to the guidelines of the Japanese Research Society for Gastric Cancer (JRSGC). A strict quality-control system was guaranteed by a supervising surgeon of the reference center, who had stayed at the National Cancer Center Hospital, Tokyo, to learn the standard D2 gastrectomy. The standard procedure entailed removal of the level 1 and 2 lymph nodes. During total gastrectomy, the pancreas was preserved according to the Maruyama technique. RESULTS: Between May 1994 and December 1996, 191 eligible patients were entered onto the study. The mean number of lymph nodes removed was 39. The overall morbidity rate was 20.9%. Surgical complications were observed in 16.7% of patients. Reoperation was necessary in six patients and was always successful. The overall hospital mortality rate was 3.1%; it was higher after total gastrectomy (7.46%) than after distal gastrectomy (0.8%). The average length of hospital stay was 17 days. CONCLUSION: Given that postoperative morbidity and mortality rates are favorably comparable with those reported after the Western standard gastrectomy, the more extensive Japanese procedure with pancreas preservation can be regarded as a safe radical treatment of gastric cancer for selected Western patients treated in experienced centers.

Adenocarcinoma↗
PubMed2003

[Clinical significance of a standardized clinical pathway in gastrectomy patients].

UNLABELLED: In traditional practice patterns, physicians take care of all clinical decisions, such as diagnosis, treatment, and recovery. In the Nippon Medical School Hospital a clinical pathway for distal gastrectomy patients, recorded as a post-operative care map, was introduced in August 2000. In January 2001 the post-operative management was analyzed and standardization of practice was carried out with printed order sets, such as drugs and infusion solutions. The aim of this study was to evaluate the clinical significance of the clinical pathway for gastrectomy patients by employing standardized postoperative management and printed order sets. PATIENTS AND METHODS: From January 2001 to December 2001, 87 patients underwent distal (43), total (28), proximal (7) and partial gastrectomy (9) for gastric cancer (stage IA: 47, IB: 9, II: 7, IIIA: 8, IIIB 2, IV: 10) and gastrointestinal stromal tumor (4). These patients were randomly assigned to either the main building or the east building of our hospital. In the main building 38 patients were looked after using traditional practice (control group). In the east building 47 patients were looked after according to the clinical pathway (path group) and 2 patients were excluded from the path group because of neo-adjuvant chemotherapy and severe heart failure. Aspects of the patients' outcomes, including length of stay, the first day of the diet, morbidity, and medical costs, were compared between the path group and the control group. All data were expressed as means+/-standard deviation. Statistical analyses were made using Student t-test, Mann-Whitney U-test, and chi(2) test, and the 5%level was chosen for statistical significance. RESULTS: The length of the hospital stay was 27.1+/-10.0 and 40.8+/-26.1 days (p<0.005) and the length of post-operative stay was 18.1+/-9.5 and 28.2+/-22.3 days (p<0.01) in the path group and the control group, respectively. The post-operative day when the diet was started for the path and control groups was 6.8+/-8.9 and 8.2+/-7.2, respectively; however, the length of the intravenous infusion for the two groups was 11.8+/-1.1 and 16.5+/-1.2 days (p<0.01), respectively. There was no statistically significant difference in the morbidity rate between the path group (3/47) and the control group (5/38). The total cost was 1,502,587 yen +/-41,650 in the path group and 1,932,197 yen +/-131,030 in the control (p<0.001). CONCLUSION: A clinical pathway for gastrectomy patients proved useful to optimize their postoperative care, including medication management and diet education. It is suggested that the implementation of a standardized clinical pathway for gastrectomy patients reduced the length of the hospital stay and the medical costs.

Critical Pathways↗
PubMed2005

Gastric glassy cells: a study of 3202 gastrectomy specimens from dwellers of the Atlantic and Pacific basins.

Fifteen years ago we detected gastric cells with glassy cytoplasm (GCs) in the human pyloric antrum. The frequency of these cells was subsequently investigated in sections from gastrectomies carried on in populations dwelling on the rim of the Atlantic and Pacific basins. In this work we compared the results obtained in these disparate geographic regions. We reviewed sections from 3203 gastrectomies (1942 in the Atlantic basin and 1261 in the Pacific basin). In the Atlantic basin 12/1942 (0.6%) of the gastrectomies had GCs, whereas in the Pacific basin 26/1261 (2.1%) of the gastrectomies had GCs. The difference was significant (p<0.05). The proportion of gastrectomies with GCs was higher in patients in Vancouver, Canada, than in New York, and higher in Santiago de Chile than in Buenos Aires, despite the fact that these populations reside at approximately the same geographic latitude. Previous studies with the same material indicated that both the extension of intestinal metaplasia and the frequency of ciliated metaplasia were significantly higher in the Pacific than in the Atlantic basin. Hence, the difference in the frequencies of GCs appears to be a new indication that dissimilar environmental exposures in the two basins might have influenced the histological make-up of the gastric mucosa.

Aged↗
PubMed2006

Dual-phase 3D CT angiography during a single breath-hold using 16-MDCT: assessment of vascular anatomy before laparoscopic gastrectomy.

OBJECTIVE: In this study, we evaluated the efficacy of dual-phase 3D CT angiography (CTA) during a single breath-hold using 16-MDCT in the assessment of vascular anatomy before laparoscopic gastrectomy. MATERIALS AND METHODS: The study involved 20 consecutive patients (10 men, 10 women; mean age, 59 years) scheduled for laparoscopic gastrectomy for the treatment of early gastric cancer. A dual-phase contrast-enhanced CT scan using 16-MDCT was obtained before laparoscopic gastrectomy. After rapid infusion of a nonionic contrast agent, arterial and venous phase scans were obtained serially with an interval of 15 sec during a single breath-hold of 31 sec. Three-dimensional CTA images in the arterial phase (3D CT arteriography) and venous phase (3D CT venography) were individually reconstructed using the volume-rendering technique, and then the images were fused together. We evaluated the detectability of the celiac trunk, left gastric artery (LGA), right gastric artery (RGA), left gastric coronary vein (LCV), Henle's gastrocolic trunk, right gastroepiploic vein (RGEV), and accessory right colic vein on 3D CTA to compare with surgical findings. RESULTS: In all 20 patients, 3D CT arteriography and venography clearly showed the celiac trunk, LGA, RGA, Henle's gastrocolic trunk, RGEV, and accessory right colic vein, which were correctly identified during surgery. The branching pattern of the celiac trunk was classified as Michels type I in 19 patients and Michels type II in one patient. Imaging showed the RGA originating from the proper hepatic artery (PHA) in nine patients; from the gastroduodenal artery (GDA) in seven patients; and from the left hepatic artery (LHA) in four patients. In 12 patients, the LCV joined the portal vein (PV) and in eight, the splenic vein (SV). In all patients, the accessory right colic vein joined the RGEV, and Henle's gastrocolic trunk proximal to the joining point flowed to the superior mesenteric vein (SMV). In all 20 patients, the fused image simultaneously showed arteries and veins around the stomach, with no mismatch between the arterial and venous phase images. In 10 patients, the LCV joined the PV after running along the dorsal side of the PHA, common hepatic artery (CHA), or splenic artery (SA). In eight patients, the LCV joined the SV after running along the ventral side of the PHA, CHA, or SA. In two patients, the LCV joined the PV after running along the ventral side of the CHA, which correlated with the surgical findings. Both the sensitivity and positive predictive values of 3D CTA revealed 100% correct identification of the celiac trunk, LGA, RGA, LCV, Henle's gastrocolic trunk, RGEV, and accessory right colic vein. CONCLUSION: Dual-phase 3D CTA using 16-MDCT clearly revealed individual arteries and veins around the stomach before laparoscopic gastrectomy. The fused image of 3D CT arteriography and venography during a single breath-hold enabled the simultaneous assessment of arteries and veins before laparoscopic gastrectomy.

Aged↗
PubMed2000

Study of cholelithiasis after gastrectomy.

We studied cholelithiasis that occurred after gastrectomy in 52 patients (35 males and 17 females) encountered at our department between January, 1978 and December, 1998. Gastrectomy had been performed for gastric or duodenal ulcer in 35, gastric cancer in 14, gastroptosis in 2, and gastric trauma in 1 of these patients. Reconstruction after gastrectomy was performed by the Billroth II method (B-II method) in 31 patients, Billroth I method (B-I method) in 17, Roux-en-Y method (Roux-Y method) in 3, and esophagogastrostomy in 1. The period between gastrectomy and discovery of gallstones was 1-5 years in 9, 5-10 years in 10, and 10 years or longer in 33, or more than 60% of the patients. Gallstones were present in the gallbladder alone in 33, bile duct alone in 9, gallbladder and bile duct in 10; the percentage of bile duct stones was high. The type of stones was bilirubin-calcium stones in 21, black stones in 12, pure cholesterol stones in 1, combined stones in 4, mixed stones in 12, and others in 2; pigment stones accounted for 63.5%. Gallstones were symptomatic in 78.8% of the patients, and abdominal pain was the most frequent symptom. Bile was positive on bacterial culture in 68.4%, and Gram-negative bacilli were the most frequently isolated. Lymph node dissection, vagotomy, cholestasis, and biliary tract infection are considered to be related to cholelithiasis after gastrectomy.

Adult↗
PubMed1989

Fat malabsorption in patients before and after total gastrectomy, studied by the triolein breath test.

The feasibility of using the triolein breath test to demonstrate fat malabsorption was evaluated in a prospective study of patients before and after total gastrectomy and Roux-en-Y reconstruction. Two of 11 patients had subnormal fat absorption before the operation, but 1 and 6 months after the operation 9 of 11 patients had subnormal fat absorption. Peak expiratory 14CO2 (median (range] at the three investigations was 3.9%/h (2.1-5.9%/h), 2.1%/h (1.4-4.5%/h), and 2.0%/h (1.2-6.0%/h), respectively. Patients who underwent a Nissen fundoplication were used as controls. They had normal fat absorption both before and after operation. Serum amylase was not appreciably affected by total gastrectomy and was similar to control values. In contrast, serum albumin decreased 1 month after gastrectomy and recovered after 6 months. In control patients pre- and post-operative albumin concentrations did not differ and were comparable to preoperative albumin values in the total gastrectomy group. The lowered fat absorption may be explained by duodenal bypass with decreased pancreatic stimulation, and it may in part explain the weight loss in patients operated on with total gastrectomy.

Aged↗
PubMed2005

Gastric cancer surgery in cirrhotic patients: result of gastrectomy with D2 lymph node dissection.

AIM: To explore the feasibility of performing gastrectomy with D2 lymphadenectomy in gastric cancer patients with liver cirrhosis. METHODS: A total of 7,178 patients were admitted with a diagnosis of liver cirrhosis from January 1993 to December 2003. We reviewed the records of 142 patients who were diagnosed with liver cirrhosis and gastric adenocarcinoma during the same period. Gastrectomy with D2 lymph node dissection for carcinoma of the stomach was performed in 94 patients with histologically proven hepatic cirrhosis. RESULTS: All but 12 patients were classified as Child's class A. Only 35 patients (37.2%) were diagnosed with cirrhosis before operation. Seventy-three patients underwent a subtotal gastrectomy (77.7%) and 21 patients (22.3%) underwent a total gastrectomy, each with D2 or more lymph node dissection. Two patients (3.8%) who had prophylactic intra-operative drain placement, died of postoperative complications from hepatorenal failure with intractable ascites. Thirty-seven patients (39.4%) experienced postoperative complications. The extent of gastric resection did not influence the morbidity whereas serum aspartate aminotransferase level (P = 0.011) and transfusion did (P = 0.008). The most common postoperative complication was ascites (13.9%) followed by wound infection (10.6%). CONCLUSION: We concluded that the presence of compensated cirrhosis, i.e. Child class A, is not a contraindication against gastrectomy with D2 or more lymph node dissection, when curative resection for gastric cancer is possible. Hepatic reserve and meticulous hemostasis are the likely determinants of operative prognosis.

Adult↗