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The authors have perfected the method of needle catheter jejunostomy introduced in 1973 for enteral feeding. Using the Seldinger technique reduces the risks of leakage, intra-operative haematoma and fistula following removal of the catheter. The operative procedure is described and the preliminary results are reported.
1. The jejunostomy route for the intraoperative insertion of a Baker tube carries significant and probably excessive risks. 2. Such risks can be greatly reduced by introducing the Baker tube through a cecostomy or a gastrostomy. When possible, introduction through an ileal stoma or through the rectum when an ileoproctostomy has been performed, is probably even better. 3. For most patients, the cecostomy approach, if performed with great care, will prove to be safe, convenient, and effective.
In order to explore the mechanism of secondary gastric acid hypersecretion after Roux-en-Y Cholangio-jejunostomy (CJR-Y), we studied the changes of gastric acid secretion and determined the levels of somatostatin (SS), gastrin (Gn), neurotensin (NT), beta-endorphin (beta-EP) in serum, gastric juice and pyloric antrum in patients with CJR-Y. The results showed that gastric hypersecretion developed, levels of SS in those specimens decreased significantly and the content of Gn increased obviously after CJR-Y; whereas the content of NT and beta-EP did not change significantly. We concluded that the decreased level of SS plays a role in the mechanism.
A technic of esophago-jejunostomy in the neck is described which uses a Y loop, to which is given a further blood supply through the internal mammary vessels, united to the vessels of the transplanted loop through microsurgical anastomoses. This technic is used either for purely palliative reasons or when the esophageal tumour has become inoperable, or after esophagectomy as a procedure for reconstruction of the digestive tract.
Effective pain control in chronic pancreatitis can be accomplished by pancreatic resection or decompression. Pancreatico-jejunostomy (PJ) has been reported to be effective for relieving pain in 70-80% of cases. The present study analyzes the authors' long-term results with PJ in the treatment of pancreatic pain. From 1963 to 1993, 49 patients with chronic pancreatitis underwent PJ for uncontrollable pain. General and radiologic characteristics, intraoperative findings and outcome were analyzed. Mean age was 35 +/- 13 years, 34 were male and 15 female. Alcoholic etiology was documented in 23 patients. Multiple pancreatic calcifications were found in 33 patients. Pancreatic biopsy confirmed chronic pancreatitis in all patients. There was one operative mortality, 12 minor, and 4 major complications. In a mean follow-up of 6.5 years, 98% of the total group was found to be free of pain. Pancreatic function remained stable in most patients. PJ is an excellent procedure for pain control that allows stable pancreatic function.
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In a 37-year-old woman with recurrent stenosis of a biliary digestive tract anastomosis and subsequent formation of bile stones, current methods of percutaneous management were useful in dilating the stenotic areas but could not remove a single bile stone within the left hepatic duct. It was successfully treated by using extracorporeal shock wave lithotripsy (ESWL) without major side effects.
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