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At least 379 records · Page 21Linked to original sources
PubMed2006

Total and subtotal laparoscopic gastrectomy for adenocarcinoma.

BACKGROUND: Laparoscopic gastrectomies are currently performed in many centers, but compliance with oncologic requirements still represents a subject open to debate. The aim of this work was to compare the short-term and oncologic outcomes after laparoscopic and open surgery in gastric adenocarcinoma. METHODS: From June 2000 through June 2005, 147 patients in our institution underwent gastrectomy by open or mininvasive approach for adenocarcinoma. The laparoscopy group included 48 patients, 29 with early gastric cancer (EGC) and 19 with antral advanced gastric cancer (AGC). The short-term results and oncologic data were compared to those obtained in 99 patients who underwent open surgery. Survival in the laparoscopy group was analyzed. RESULTS: In the laparoscopy group no intraoperative complications were observed, and conversion was needed in only one patient with a large advanced tumor. Overall, 32 lymph nodes were collected by D2 dissection, 30 for EGC, 34 for advanced cancers. The resection margin was 6.7 cm (range: 4-8 cm). The mean operating time was 240 min (range: 150-360 min), with a blood loss of 150 ml on average (range: 70-250 ml). Morbidity included two duodenal leaks that healed without reoperation; after enclosing or reinforcing the staple line, no further leaking was noted. There was one death from massive bleeding in a cirrhotic patient. Ambulation and oral feeding started significantly earlier than in open surgery. The mean hospital stay was 10 days (range: 7-24 days), significantly shorter than the stay of 18 days after open surgery (p < 0.05). All patients treated laparoscopically were alive without recurrence at the end of this study. CONCLUSIONS: Short-term results with laparoscopic gastrectomy were better than with open surgery in this study. Oncologic radicality was a major concern, but in the authors' experience the extent of lymphadenectomy was the same as in open surgery. This study suggests that laparoscopic gastrectomy in malignancies is a reliable tool and oncologic requirements can be warranted.

Adenocarcinoma↗
PubMed2006

Technique and assessment of sentinel lymph node biopsy usefulness in laparoscopy-assisted distal gastrectomy.

BACKGROUND: Recently, some studies have suggested that sentinel node biopsy also can be applied to gastric cancer. The authors apply sentinel lymph node biopsy in laparoscopy assisted distal gastrectomy to perform it as safe limited surgery. Limited surgery is a procedure in which the extent of lesion resection and lymph node dissection is reduced. The authors demonstrate that intraoperative diagnosis of lymph node metastasis is useful in this respect. METHODS: The study was conducted with 38 patients (29 men and 9 women) who had a preoperative diagnosis of T1 tumor invasion. The patients had a mean age of 66.2 years. Patent blue (1%) was injected submucosally into four or five different sites around the primary tumor at 1 ml per site. Blue-stained lymphatics and lymph nodes could be seen by turning over the greater omentum and the lesser omentum extraperitoneally. If blue nodes were found, biopsy was performed. RESULTS: The mean number of blue nodes dissected was 2.5 +/- 1.9. Intraoperative identification and biopsy of blue nodes could be performed for 35 (92.1%) of the 38 patients. Of the 35 patients in whom blue nodes were identified, 4 (9.7%) had metastases in blue nodes confirmed by intraoperative frozen-section diagnosis. Intraoperative frozen-section diagnosis was negative for blue node metastasis in 31 patients. Postoperative permanent section diagnosis also showed no evidence of lymph node metastasis in these 31 patients (100% accuracy, 0% false-negative rates). CONCLUSION: The reported method allows observation of blue-stained lymphatics up to 2 h after patent blue injection. Sentinel node biopsy was performed in laparoscopy assisted distal gastrectomy, making it technically equivalent to open gastrectomy. Sentinel node biopsy can serve as a method to determine the appropriate use of laparoscopy assisted distal gastrectomy for management of T1 gastric cancer.

Aged↗
PubMed2000

Laparoscopically assisted distal gastrectomy for early gastric cancer: is it superior to open surgery?

BACKGROUND: The purpose of this study was to compare clinical outcomes between laparoscopically assisted and open distal gastrectomy for early gastric cancer. METHODS: The records of 21 patients who underwent laparoscopically assisted distal gastrectomy (LG) for preoperative diagnosis of intramucosal gastric carcinoma between January 1996 and August 1998 were reviewed and compared with those of 31 open distal gastrectomy patients during the same period. RESULTS: Age, gender, and size and histologic differentiation of the lesions were matched. Those located at the body of the stomach (p = 0.011) and those macroscopically depressed (p = 0.049) were subjected more frequently to open surgery. Laparoscopically assisted gastrectomy required significantly longer operative time (p < 0.001) with less extensive lymph node dissection (p < 0.001). However, time to start of walking (p = 0.032), time to flatus (p = 0.002), duration of postoperative fever (p = 0.027), and postoperative hospital stay (p = 0.001) were significantly shorter in the LG group, and this group had a lower white blood cell count on the first postoperative day (p = 0.010). Blood loss and time to oral intake were comparable between the groups. Complications included one conversion to open surgery, one leakage, and one stenosis in the LG group, and two leakages and an atelectasis in the OG group. CONCLUSIONS: Although LG requires longer surgical time, this retrospective study suggests that it is superior to open surgery in terms of faster postoperative recoveries, shorter hospital stays, and cosmetic outcomes.

Adenocarcinoma↗
PubMed2004

Altered contractile responsiveness in ileal longitudinal muscle after total gastrectomy in a rat model.

PURPOSE: To test the hypothesis that the changes in ileal smooth muscle contractility accompanying postgastrectomy syndromes are agonist-specific, we investigated the effects of potassium chloride (KCl), carbachol, substance P (SP), and serotonin on ileal smooth muscle contractility after total gastrectomy in rats. METHODS: We performed total gastrectomy in ten rats and a sham operation in another ten rats as a control. All of the rats were killed and their ileums excised 4 weeks postoperatively. The concentration-response relationships for KCl, SP, and serotonin were obtained by adding each agent cumulatively to the organ bath. Morphological changes in the ileum were also examined by light microscopy. RESULTS: There was no significant difference between the responsiveness of gastrectomized and control tissues to KCl. Maximum responses (E(max)) to carbachol and SP were less in the gastrectomized ileal segments than in the control ileal segments. E(max) to serotonin was higher in the gastrectomized ileal segments than in the control ileal segments. The pD(2)value, i.e., the negative logarithm of the concentration for the half-maximal response, EC(50), for carbachol, SP, and serotonin was unchanged in the gastroctomized ileal segments and the control segments. Total gastrectomy also caused morphological changes in the ileum. CONCLUSIONS: These data indicate that the contractile response to various agents is altered after total gastrectomy and that receptor-mediated mechanisms may cause these changes.

Animals↗
PubMed2003

Skeletonizing en-bloc gastrectomy for adenocarcinoma in Caucasian patients.

BACKGROUND: The prognostic relevance of a Japanese-like lymphadenectomy for gastric adenocarcinoma is Caucasian patients is not well establishes. METHODS: Skeletonizing en-bloc gastrectomy (SEBG) (including removal of the stomach, excision of the potentially involved lymph nodes, and skeletonization of the main anatomic structures in the upper abdominal floor) was attempted in 216 consecutive patients with adenocarcinoma of the stomach. Gastrectomy was total in 143 patients, and subtotal in 72. One debilitated patient had a wedge resection of the gastric wall. RESULTS: SEBG was performed in 160 patients (74%), whereas 56 patients (26%) had a palliative gastrectomy (PG) without lymph node dissection. The feasibility rate of SEBG was influenced significantly ( P < 0.001) by the depth of wall penetration, so that it dropped from 97% in T1 tumors to 91%, 65%, and 17% in those classified T2, T3, and T4, respectively. The 5-year survival rate, including postoperative mortality (0.9%) was 48% for the whole series, 66% after SEBG, and 0% after PG. The 5-year survival rate after SEBG was related significantly to the lymph node involvement (N0, 75% vs N+, 54%; P = 0.008) and to its magnitude (N+, <5 metastatic lymph nodes, 62% versus N+, > or =5 metastatic lymph nodes, 39%; P = 0.018). Considering the fact that 9 patients died of an unrelated cause before the postoperative term of 5 years, the cancer-related survival rate 5 years after SEBG was 71% in the whole group of 160 patients. This survival rate was 82% in patients with normal lymph nodes, versus 56% in those with metastatic nodes ( P < 0.001). CONCLUSIONS: SEBG was feasible in three-quarters of a po-pulation of Caucasian patients operated on for gastric adenocarcinoma. SEBG provided a chance for a longterm favorable outcome in three-quarters of patients with normal lymph nodes and in more than half of those with metastatic lymph nodes. These results are similar to those achieved after radical gastrectomy in Japanese patients with gastric adenocarcinoma. The prognostic relevance of a Japanese-like lymphadenectomy for gastric adenocarcinoma in Caucasian patients is not well established.

Adenocarcinoma↗
PubMed2006

Laparoscopic gastrectomy with lymph node dissection for gastric cancer.

Since 1991, laparoscopic surgery has been adopted for the treatment of gastric cancer, and it has been performed worldwide, especially in Japan and Korea. We reviewed the English-language literature to clarify the current status of and problems associated with laparoscopic gastrectomy with lymph node dissection as treatment for gastric cancer. In Japan, early-stage gastric cancer (T1/T2, N0) is considered the only indication for laparoscopic gastrectomy. As yet, there is little high-level evidence based on long-term outcome supporting laparoscopic gastrectomy for cancer, but reports have provided level 3 evidence that the procedure is technically safe, and that it yields better short-term outcomes than open surgery; that is, recovery is faster, hospital stay is shorter, there is less pain, and cosmesis is better. However, investigation into the oncological outcome of laparoscopic gastrectomy as treatment for cancer is lacking. To establish laparoscopic surgery as a standard treatment for gastric cancer, multicenter randomized controlled trials to compare the short- and long-term outcomes of laparoscopic surgery versus open surgery are necessary.

Carcinoma↗
PubMed2003

Subjective and functional results after total gastrectomy: prospective study for longterm comparison of reconstruction procedures.

BACKGROUND: many reconstruction procedures have been developed in efforts to resolve patients' complaints after total gastrectomy. however, there have been few reports of longterm comparisons between reconstruction procedures, especially with regard to the prevention of duodenal food passage. this study was undertaken to compare the longterm subjective and functional results among roux-en-y esophagojejunostomy (r-y), r-y with pouch (p-y), and jejunal interposition with pouch (p-i) after total gastrectomy. METHODS: consecutive patients requiring curative total gastrectomy were enrolled in this prospective study by the envelope method. RESULTS: hospital stay was longer following a p-i than an r-y or a p-y. over 50% of r-y patients complained of heartburn, and 20% of r-y patients showed dumping syndrome throughout the postoperative period, with this rate being significantly different from rates in the other two groups. p-y patients complained of early satiety in the late postoperative period, while p-i patients complained of early satiety in the early postoperative period. the nutritional index in p-i patients was higher than those in patients with the other two procedures. gastrointestinal and hepatobiliary dual scintigraphy (ghds) showed that the rate of bile reflux with an r-y was relatively high after surgery. food reflux with a p-y was increased (9.4% to 11.1%), but with a p-i food reflux was decreased at 3 years after surgery (13.3% to 9.9%). patients with a p-y had a faster recovery of body, weight in the early postoperative period; however, at 5 years after operation, body weight recovery with a p-i was greatest. CONCLUSION: reconstruction should be performed with pouch formation after total gastrectomy with curative intent.

Adult↗
PubMed2004

Tuberculosis associated with gastrectomy.

We describe the incidence and clinical features of patients with tuberculosis who had undergone gastric resection in our hospital. A total of 26 patients with tuberculosis who had undergone gastric resection were studied. The prevalence of gastrectomy among patients with tuberculosis was 8.0% (7/87) in 2000, 5.1% (4/78) in 2001, and 13.2% (10/76) in 2002. The average 3-year incidence was 9.1%. The patients' body mass indexes (BMIs) were below 18 kg/m2 in 9 of the 21 patients in whom it was possible to determine BMI and above 22 kg/m2 in only 2 of these 21 patients. Analysis of impaired glucose tolerance revealed oxyhyperglycemia or diabetes mellitus as one risk factor for the development of tuberculosis. Furthermore, poor nutrition among patients who have undergone gastrectomy may provide prognostic information for the development or reactivation of tuberculosis. In Japan, a fairly large percentage of elderly people have undergone gastrectomy for gastric cancer or gastric ulcer, and many have a past history of tuberculosis. Gastrectomy may be a risk factor for the reactivation of tuberculosis.

Aged↗
PubMed2006

Trypsin activity and bile acid concentrations in the esophagus after distal gastrectomy.

The pathogenesis of reflux esophagitis is not well understood and remains controversial. Distal gastrectomy serves as a model to assess the role of duodenal reflux with low gastric acidity in the development of reflux esophagitis. We investigated the relationship between the severity of esophagitis and gastroduodenal juice reflux, with particular focus on trypsin and bile acids after distal gastrectomy reconstructed with Billroth I anastomosis. Twenty-eight patients with gastroesophageal reflux disease after distal gastrectomy were enrolled. Esophageal and duodenal contents were aspirated under endoscopical examination, and their trypsin activity and bile acid concentrations were measured. The grade of reflux esophagitis was assessed by endoscopy and the symptoms were scored. Moreover, the grade of infiltration of inflammatory cells and the expression of COX-2 mRNA in the esophageal epithelium were evaluated. Patients with severe esophagitis had a higher amount of trypsin activity and bile acid concentrations in the esophagus, but not in the duodenum, compared to patients with mild esophagitis (P < 0.05). There was a strong positive correlation between the trypsin activity and the bile acid concentrations in the esophagus (r = 0.743, P = 0.0001). Moreover, the COX-2 mRNA expression and the grade of infiltrating inflammatory cells in the esophageal mucosa significantly correlated with the trypsin activity and bile acid concentrations in the esophagus. Thus, duodenogastroesophageal reflux with low gastric acidity is one of the pathogeneses in the development of reflux esophagitis from the present clinical study with patients after distal gastrectomy reconstructed with Billroth I anastomosis.

Aged↗
PubMed1983

Prospective, randomized trial of selective proximal vagotomy with ulcer excision and partial gastrectomy with gastroduodenostomy in the treatment of corporeal gastric ulcer.

In a prospective, randomized trial, selective proximal vagotomy with complete ulcer excision was compared with partial gastrectomy with gastroduodenostomy for the treatment of primary corporeal gastric ulcer in 30 patients. The results were evaluated by clinical follow-up examinations at regular intervals, endoscopy, and blood tests. The mean follow-up period was 3 years for both operations. There was no mortality. Postoperative complications, ulcer recurrence rates, the overall clinical results (Visick classification), and blood test results were similar in the two groups. Three of 15 selective proximal vagotomy patients were classified grade IV due to recurrent ulcer (two patients) or dumping (1 patient), and 2 of 14 partial gastrectomy patients as were classified grades III (epigastric pain) and IV (recurrent ulcer). Considering the risk for late symptoms of impaired resorption and gastric cancer after partial gastrectomy, the similar results with selective proximal vagotomy and partial gastrectomy justify further trials of selective proximal vagotomy with ulcer excision for treatment of corporeal gastric ulcer.

Antacids↗
PubMed1986

Intestinal transit of food after total gastrectomy and Roux-Y esophagojejunostomy.

We examined small bowel transit of solid food in 10 patients 3 to 30 months after total gastrectomy and Roux-Y esophagojejunostomy and compared the transit pattern with that in five control subjects. All persons ate a test meal consisting of 213 g of beef stew mixed with 30 g of chicken liver which was labeled with 1 mCi of technetium 99m sulfur colloid, and they stood in front of a gamma scintillation camera and were studied for 6 to 10 hours. Solid food passed rapidly from the esophagus through the Roux-Y limb and became uniformly distributed throughout a long segment of the small intestine. Mouth-to-colon transit time was 223 +/- 18 minutes in the control subjects and 298 +/- 37 minutes in the patients with gastrectomy. Small bowel transit of the head of the meal was 187 +/- 19 minutes in the control subjects and 293 +/- 37 minutes in the patients (p less than 0.02). Transit time of the tail of the meal was 175 +/- 26 minutes in the control subjects and 396 +/- 28 minutes in the patients (p less than 0.001). After total gastrectomy and Roux-Y esophagojejunostomy, the proximal jejunum does not act as a reservoir; transit of food through the small intestine is slower than in control subjects, and because the proximal jejunum empties rapidly during eating, a meal of normal size can be consumed. These findings do not support the idea that an artificial gastric reservoir is important after total gastrectomy.

Adult↗
PubMed1995

A 10-year experience of intraoperative radiotherapy for gastric carcinoma and a new surgical method of creating a wider irradiation field for cases of total gastrectomy patients.

PURPOSE: To improve the prognosis of gastric cancer, radical surgical resection with extensive lymph node dissection plus intraoperative radiation therapy (IORT) was tried in our clinic. In addition, a new operative procedure was created to obtain wider irradiation field for total gastrectomy patients. METHODS AND MATERIALS: A total of 183 gastric cancer patients who underwent radical gastrectomy with or without IORT from August 1983 to July 1992 were retrospectively evaluated. The patients were divided into two groups: group 1 consisted of 58 patients who underwent radical operation plus IORT. A single dose of 28 to 30 Gy was delivered around the celiac axis with an electron beam of 12 MeV. Group 2, our historical control group, which showed no difference in age, sex and stage, consisted of 120 patients who underwent only radical surgery. In addition, a new method of total gastrectomy with IORT after mobilization of the tail and body of the pancreas was devised to get wider irradiation field for advanced gastric cancer. RESULTS: Of the Stage II gastric cancer patients, all the 11 patients of group 1 are alive, whereas in group 2, the 4-year and the 8-year survival rates were 60% and 48%, respectively. In Stage III patients, the 8-year survival rate of group 1 was 55% vs. 35% in group 2. As for Stage IV patients, the 5-year survival rate of group 1 was 12% and that of group 2 was 13%. CONCLUSION: Using this combined treatment modality of radical surgical operation+IORT, improved survival rates were obtained for Stage II and III gastric cancer patients. However, the method was ineffective for more advanced, Stage IV, patients. The wider irradiation field method used for total gastrectomy patients was safe and no complications were encountered.

Adult↗
PubMed2005

Oral trypsin inhibitor can improve reflux esophagitis after distal gastrectomy concomitant with decreased trypsin activity.

BACKGROUND: The pathogenesis of reflux esophagitis is not well understood and remains controversial. Distal gastrectomy serves as a model to assess the role of duodenal reflux with low gastric acidity in the development of reflux esophagitis. We investigated the clinical usefulness and antitrypsin activity after treatment with a trypsin inhibitor, camostat mesilate, against the reflux esophagitis after distal gastrectomy reconstructed with Billroth-I anastomosis. METHODS: Twenty-eight patients with gastroesophageal reflux disease after distal gastrectomy were prescreened according to esophageal pH level and trypsin activity, and consequently 11 patients were enrolled in the present clinical study. Esophageal and duodenal washings were aspirated for the evaluation of the pretreatment trypsin activity. Then 100 mg of camostat mesilate was administered orally. At 30 and 120 minutes after the administration, duodenal washings were aspirated for the evaluation of posttreatment trypsin activity. Thereafter, 300 mg of camostat mesilate was administered orally 3 times daily for a 4-week period. On the 28th day of administration, the grade of reflux esophagitis (Los Angeles classification) was re-evaluated under endoscopy and the esophageal washings were aspirated for the evaluation of trypsin activity. RESULTS: The trypsin activities in the duodenum both at 30 and 120 minutes after oral ingestion of camostat mesilate were decreased significantly in comparison with those in the pretreatment period in each patient (P<.001). In 6 of 7 patients with detectable trypsin activity in the esophagus, the activities after the 28th day of treatment were lower than those in the pretreatment period, and the symptoms were milder than those before treatment (P<.05). Furthermore, endoscopic evaluation showed that 40% of patients were grade B, C, and D after treatment (28th day), whereas 70% of patients were grade B, C, and D before the treatment. CONCLUSIONS: Oral administration of trypsin inhibitor can improve reflux esophagitis after distal gastrectomy concomitant with decreased trypsin activity.

Administration, Oral↗
PubMed2005

The role of follow-up endoscopy after total gastrectomy for gastric cancer.

BACKGROUND: Follow-up endoscopy after total gastrectomy for gastric cancer is commonly performed without there being any definite evidence of clinical relevance. Therefore, we investigated the role of the upper endoscopic examinations after total gastrectomy for gastric cancer. METHODS: The medical records of 212 early gastric cancer (EGC) patients and 622 advanced gastric cancer (AGC) patients who underwent follow-up endoscopic examination after total gastrectomy between 1994 and 2001 were reviewed. RESULTS: Two of 212 EGC patients and 233 of 622 AGC patients revealed tumour recurrence at all sites. All the endoscopically accessible local tumour recurrences (n=24) were found in the AGC group. Anastomosis site stenosis was detected in 72 of 834 patients. CONCLUSION: Follow-up endoscopy after total gastrectomy for gastric cancer is useful in detecting complications and tumour recurrence. However, this procedure has a limited role in the clinical management and overall survival for patients with recurrent gastric adenocarcinoma.

Adenocarcinoma↗
PubMed2004

Effect of semifundoplication with subtotal gastrectomy for prevention of postoperative gastroesophageal reflux.

BACKGROUND: Postgastrectomy patients often experience reflux esophagitis and a compromised quality of life. We hypothesized that reconstructive methods with antireflux procedures at operation should prevent reflux esophagitis and improve the likelihood of a better quality of life in patients after distal gastrectomy for gastric carcinoma. Our antireflux procedure was a subdiaphragmatic semifundoplication. We aim to substantiate, with objective arguments, potential advantages of Billroth I simple reconstruction versus Billroth I with semifundoplication. STUDY DESIGN: This study evaluated 60 patients who had Billroth I reconstruction with semifundoplication (30 patients; F group) and simple Billroth I reconstruction (30 patients; B group) after distal gastrectomy for gastric cancer. Assessments were made preoperatively and 6 months or later after surgical intervention. Results of the procedure, clinical evaluation (reflux symptoms), and esophageal alkaline reflux by ambulatory 24-hour pH memory were satisfactory. RESULTS: Operative evaluation time and procedural complications did not differ significantly between the two gastrectomy groups. Reflux symptoms only occurred in 12 patients in the B group. Lower esophageal sphincter pressure of patients in the B group was significantly lower than that of patients in the F group and in preoperative states (p < 0.05). The mean appearance of alkaline esophageal reflux in the F group and the B group were 2.6% and 13.6%, respectively (p < 0.01). Patients with semifundoplication had a significantly better quality of life and less physiologic regurgitation than patients with simple Billroth I. CONCLUSIONS: This study demonstrated that Billroth I reconstruction with semifundoplication for gastric cancer is not only effective for patients with a postoperative life expectancy, but also prevents reflux esophagitis after gastrectomy. We believe that our method is an effective and simple surgical option for many patients with gastric cancer.

Aged↗
PubMed2005

Laparoscopic assisted distal gastrectomy for early gastric cancer: Five years' experience.

BACKGROUND: Laparoscopic assisted gastrectomy is being reported increasingly as the treatment of choice for early gastric cancer. However, no reports concerning the prognosis of patients who have undergone laparoscopic assisted distal gastrectomy (LADG) for early gastric cancer or data comparing the results to those obtained after open gastric surgery are yet available. METHODS: A retrospective study was performed comparing laparoscopic assisted and open distal gastrectomies for early gastric cancer. Eighty-nine patients who underwent LADG were compared to 60 who underwent conventional open distal gastrectomy (DG) in terms of pathologic findings, operative outcome, complications, and survival. RESULTS: There were no significant differences between LADG and DG in operation time (209 vs 200 minutes), complication rate (9% vs 18%), and 5-year survival rate (98% vs 95%). There were differences between LADG and DG with regard to blood loss (237 vs 412 mL), number of lymph nodes (19 vs 25), postoperative stay (17 vs 25 days), and the duration of epidural analgesia (2 vs 4 days) ( P < .05 each). CONCLUSIONS: For properly selected patients, LADG can be a curative and minimally invasive treatment for early gastric cancer.

Early Diagnosis↗
PubMed1995

Cholecystokinin is partly responsible for reduced food intake and body weight loss after total gastrectomy in rats.

PURPOSE: To determine the cause of body weight loss after total gastrectomy. METHODS: We evaluated the acute effect of exogenous cholecystokinin (CCK) on food intake and the chronic effect of CCK receptor blockade on food intake and body weight after total gastrectomy in rats. RESULTS: Exogenous CCK significantly reduced food intake in gastrectomized rats; this was blocked by administration of a CCK-A but not a CCK-B receptor antagonist. Chronic treatment with a CCK-A or CCK-B receptor antagonist after total gastrectomy in rats significantly increased postoperative food intake and body weight. CONCLUSION: Our data indicate that endogenous CCK is partly responsible for reduced food intake and body weight loss after total gastrectomy in rats.

Animals↗
PubMedDate not supplied

Reconstruction following total gastrectomy: a review and summary of the randomized prospective clinical trials.

Reconstruction of gastrointestinal tract continuity following total gastrectomy can be achieved using a variety of operations. Worldwide, Roux-en-Y esophago-jejunostomy with or without a pouch reservoir, is the most frequently performed operation after total gastrectomy. Others have advocated the preservation of the duodenal food passage, employing an interposed segment of bowel between the esophageal remnant and duodenum as a more physiologic operation. Several methods for either approach are described. In recent years, six randomized prospective clinical trials assessing various operations for gastrointestinal reconstruction have been reported. While there is a general consensus for the indications and patient selection criteria in order to proceed with total gastrectomy, a defined optimal procedure has not been clearly established. In the present work, these recent clinical studies addressing gastrointestinal reconstruction following total gastrectomy are reviewed and summarized.

Anastomosis, Roux-en-Y↗