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PubMed1987

Argyrophil cells in the rat duodenum after gastrectomy.

Two different techniques of reconstruction after total gastrectomy were performed in rats: Roux-en-Y (RY) and jejunal interposition (JI). Sham-operated rats were used as controls. Sixteen weeks after surgery the animals were sacrificed. The distribution of the enteroendocrine cells in the duodenal and proximal jejunal mucosa was examined using the Grimelius silver nitrate stain. The frequency of the Grimelius-positive cells was estimated as number of cells per square millimeter of gut surface and as number of cells per transverse section of intestine. Intestinal villi height was also measured in the same duodenojejunal tracts. After gastrectomy, the JI rats showed a better weight gain than RY rats (p less than 0.05). A significant difference in the distribution of intestinal argyrophil cells was seen. The bypassed duodenojejunal tracts in RY rats showed a marked reduction of the Grimelius-positive cells in comparison with JI rats and controls (p less than 0.01). A reduction in the number of argyrophil cells in the proximal duodenum was also noticed in the JI rats in comparison with controls (p less than 0.01). A decrease in the villi height resulted in all the gastrectomized rats (p less than 0.01), but a significant decrease was also noticed in RY rats in comparison with JI (p less than 0.01). Our experimental observations suggested that the exclusion of the duodenum from intestinal transit after gastrectomy caused atrophy of the gut mucosa and a marked reduction in the number of argyrophil enteroendocrine cells in the bypassed tracts.

Anastomosis, Roux-en-Y↗
PubMed1991

Prophylactic administration of urinary trypsin inhibitor prevents postoperative hyperamylasemia after R2 gastrectomy in patients with gastric cancer. A prospective randomized trial.

The purpose of this prospective randomized study was to determine whether prophylactic administration of urinary trypsin inhibitor prevents postoperative damage to the pancreas caused by R2 gastrectomy in patients with gastric cancer, by analyzing related enzyme activities. Among the 22 patients who underwent distal partial gastrectomy together with R2 lymphadenectomy, 12 were given the drug for 3 days postoperatively, and 10 no therapeutic agent. These groups were otherwise comparable. Postoperatively, the control patients had significantly higher levels of total amylase activity in the serum and P-type amylase when compared to the preoperative data. These amylase activities almost remained at the preoperative level in those given the drug. When the ratio of increase in enzyme activities (postoperative value divided by preoperative value) were compared, on the 7th postoperative day, total amylase activity in the serum and P-type amylase were significantly different between the two groups (p less than 0.05). This difference was also evident when comparing total amylase activity in the urine (p less than 0.05). These findings indicate that prophylactic administration of urinary trypsin inhibitor would aid in preventing postoperative hyperamylasemia caused by R2 gastrectomy in patients with gastric cancer.

Adult↗
PubMed1996

Differences in gallbladder bile lithogenicity in patients after gastrectomy and colectomy.

The differences in lithogenicity of gallbladder bile, biliary lipid composition, cholesterol saturation index (CSI), cholesterol nucleation time (NT), bilirubin, and ionized calcium were compared in patients who had previously undergone gastrectomy or colectomy. The increased CSI and the rapid NT were absent in gastrectomized patients, while colectomy significantly increased the CSI and accelerated the NT. The levels of ionized calcium and unconjugated bilirubin, possibly responsible for pigment stone formation, were significantly higher in patients after gastrectomy, but were nearly absent in patients after colectomy. The results suggest that after gastrectomy the gallbladder bile indicates a trend towards pigment stone formation, whereas there is a trend towards cholesterol gallstones after colectomy. The different alterations of the gallbladder bile lithogenicity are clinically important.

Adult↗
PubMed1984

Neonatal total gastrectomy.

A 2-day-old, female infant underwent total gastrectomy for spontaneous gastric gangrene and perforation. She developed the following complications: growth retardation, vitamin B12 deficiency, post-gastrectomy dumping syndrome, and occasional bile regurgitation. Nutritional management is described. The two previously reported survivors of total gastrectomy in the neonatal period are reviewed.

Dumping Syndrome↗
PubMed2003

Laparoscopic billroth II gastrectomy for completely stricturing duodenal ulcer: technical details.

BACKGROUND: The authors report a series of three patients who underwent laparoscopic gastrectomy for gastric outlet obstruction due to stricturing duodenal ulcer. MATERIALS AND METHODS: In all cases an intracorporeal resection of the antrum and an antecolic end to side gastrojejunostomy (Billroth II) were performed. Technical details are discussed in the paper. RESULTS: Mean operative time was 260 minutes, mean blood loss was 43 millilitres. There were no postoperative complications and all patients were discharged on the fifth postoperative day. A follow up of three years shows that no patient had recurrence and post-gastrectomy syndromes. CONCLUSIONS: Laparoscopic Billroth II gastrectomy is a safe and feasible procedure with benefits such as quick hospital stay, decreased postoperative pain, good cosmesis and reduced morbidity.

Adult↗
PubMed2005

Evaluation of POSSUM scoring system in patients with gastric cancer undergoing D2-gastrectomy.

BACKGROUND: Risk adjustment and stratification play an important role in quality assurance and in clinical research. The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) is a patient risk prediction model based on 12 patient characteristics and 6 characteristics of the surgery performed. However, because the POSSUM was developed for quality assessment in general surgical units, its performance within specific subgroups still requires evaluation. The aim of the present study was to assess the accuracy of POSSUM in predicting mortality and morbidity in patients with gastric cancer undergoing D2-gastrectomy. METHODS: 137 patients with gastric cancer undergoing gastrectomy were included in this study. Detailed, standardized risk assessments and thorough documentation of the post-operative courses were performed prospectively, and the POSSUM scores were then calculated. RESULTS: The 30- and 90-day mortality rates were 3.6% (n = 5) and 5.8% (n = 8), respectively. 65.7% (n = 90) of patients had normal postoperative courses without major complications, 14.6% (n = 20) had moderate and 13.9% (n = 19) had severe complications. The number of mortalities predicted by the POSSUM-Mortality Risk Score (R1) was double the actual number of mortalities occurring in the median and high-risk groups, and was more than eight times the actual number of mortalities occurring in the low-risk group (R1 < 20%). However, the calculated R1 predicted rather well in terms of severe morbidity or post-operative death in each risk group: in predicted low risk patients the actual occurrence rate (AR) of severe morbidity or post-operative death was 14%, for predicted medium risk patients the AR was 23%, and for predicted high risk patients the AR was 50% (p < 0.05). The POSSUM-Morbidity Risk Score (R2) overestimated the risk of morbidity. CONCLUSION: The POSSUM Score may be beneficial and can be used for assessment of the peri- and post-operative courses of patients with gastric carcinoma undergoing D2-gastrectomy. However, none of the scores examined here are useful for preoperative prediction of postoperative course.

Adult↗
PubMed2006

Learning curve for total gastrectomy with D2 lymph node dissection: cumulative sum analysis for qualified surgery.

BACKGROUND: This study was conducted to evaluate the leaning curve of D2 lymph node dissection for patients with gastric cancer in a high-volume center. METHODS: The authors prospectively reviewed the data of all patients who underwent total gastrectomy with D2 lymph node dissection during a 4-year period. Retrieved lymph node number was used as a surrogate marker of oncological outcome. The retrieved lymph node number cut-off value required for satisfactory D2 lymph node dissection was defined as >25. Cumulative sum analysis was used to examine the learning curves of individual surgeons at target accuracy rates of 85%, 90%, 92.5%, 95%, and 98%. RESULTS: Two junior staff surgeons performed 198 curative-intent total gastrectomies with D2 lymph node dissections during the study period; their success rates exceeded 90%. Operating time decreased with operative experience (Pearson correlation coefficient = -0.515, P < 0.001). The learning period for total gastrectomy with D2 lymph node dissection for these two junior members of staff was calculated as 23-35 cases, presuming a 92.5% success rate. CONCLUSIONS: The current study suggests that the surgical learning period for D2 lymph node dissection extends to at least 23 cases or 8 months. In clinical trials containing gastric cancer surgery, the learning curve for qualified surgery from the standpoint of oncological outcome should be considered to minimize bias due to surgeon-associated factors.

Adenocarcinoma↗
PubMed1991

[Effect of FOY-305 on post-operative reflux esophagitis in rats (II). Analysis of mechanism in the pathogenesis of reflux esophagitis after total gastrectomy in rats].

Esophagitis after total gastrectomy has been associated with biliary and pancreatic reflux into the esophagus. The purpose of this study is to clarify the effect of FOY-305 on these factors in the esophagitis. We initially produced esophagitis in rats with total gastrectomy followed by an end-to-side esophago-jejunostomy (Billroth-II). After treatment of FOY-305 on post-operative day 7 in this model, esophageal washout samples were analyzed for increases in activity of trypsin and total bile acid concentration. FOY-305 completely inhibited increases of trypsin activity in 2 and 4 hr, and it significantly (P less than 0.05) reduced bile acid concentration in 4 hr after initiating treatment. In addition, we evaluated the injurious effect of trypsin and sodium taurocholate (Tc-Na) on isolated esophagus of rats by measuring released tyrosine in the medium and used it as an index of the degree of injury. Tc-Na (3-fold of enteral bile acid concentration) inflicted only a slight injurious effect with negligible tyrosine release increases, and it did not show synergistic action when concomitantly used with trypsin. However, trypsin clearly induced increased tyrosine release from the esophageal mucosa, and this effect was significantly (P less than 0.001) inhibited by FOY-305 (50 microM). These results indicate that trypsin is one of the important factors in the pathogenesis of reflux esophagitis after total gastrectomy, and FOY-305 exerts a therapeutic effect by eliciting an inhibitory action against trypsin activity.

Animals↗
PubMed2000

Dietary fructooligosaccharides prevent a reduction of cortical and trabecular bone following total gastrectomy in rats.

Fructooligosaccharides (FOS) have been shown to stimulate the absorption of several minerals in the intestine. In the present study, the effects of FOS on osteopenia induced by total gastrectomy were examined. Twenty eight male Sprague Dawley rats were divided into 2 groups: sham-operated (SH) and gastrectomized (GX). After a one-week adaptation period following surgery, the rats were fed synthetic diets with or without 7.5% FOS for 5 weeks. The right femur was then examined by soft X-ray, and the bone mineral density (BMD) was measured. Based on the soft X-ray findings, both cancellous and cortical bone were markedly decreased in GX rats, but not in GX + FOS rats. GX rats showed a 30% lower BMD in the metaphysis and a 20% lower BMD in the diaphysis, compared with SH rats (P < 0.01). As assessed by morphometry, significant decreases were observed in cortical bone in the diaphysis and trabecular bone in the distal metaphysis (P < 0.01). On the other hand, dietary FOS completely prevented these changes following gastrectomy. These findings indicate that dietary FOS might contribute to the prevention of bone diseases following gastrectomy.

Animals↗
PubMed2002

Laparoscopic Roux-en-Y gastric bypass with remnant gastrectomy for focal intestinal metaplasia of the gastric antrum.

BACKGROUND: Inaccessibilility of the excluded stomach after isolated gastric bypass prevents postoperative evaluation and treatment of disorders of the gastric remnant. Bleeding complications, peptic ulcer disease, and gastric malignancy in the gastric remnant have all been reported. We report a patient with morbid obesity and focal intestinal metaplasia in the antrum of the stomach that was treated with laparoscopic Roux-en-y gastric bypass (LRYGBP) with remnant gastrectomy. CASE REPORT: A 46-year-old female with a long history of morbid obesity presented with a BMI of 47 kg/m2. Preoperative upper endoscopy revealed focal intestinal metaplasia. Since intestinal metaplasia is a risk factor for gastric cancer, a LRYGBP with remnant gastrectomy was performed. CONCLUSIONS: LRYGBP with remnant gastrectomy is a safe and cost-effective treatment for morbidly obese patients with focal intestinal metaplasia of the stomach.

Anastomosis, Roux-en-Y↗
PubMed2006

Sleeve gastrectomy in the high-risk patient.

BACKGROUND: One of the surgical options available for the super-obese patient is the sleeve gastrectomy. We present results of this operation in a series of 118 patients. METHODS: The charts of all patients who have had the sleeve gastrectomy performed were reviewed for demographic data, complications, weight, and nutritional parameters. RESULTS: Median age was 47 years (16-70). Median BMI was 55 kg/m(2) (37-108), with 73% of patients having a BMI > or =50 kg/m(2). 41% of the patients were male. The operation was performed by laparotomy in all but three cases, which were performed laparoscopically. Median hospital stay was 6 days (3-59). There was one perioperative death (0.85%). 18 patients (15.3%) had postoperative complications. Median percent excess weight loss was 37.8% at 6 months, 49.4% at 12 months, and 47.3% at 24 months. Median follow-up was 13 months (1-66). At 1 year postoperatively, the percentage of patients with normal serum levels of albumin was 100%, hemoglobin 86.1%, and calcium 87.2%, compared to 98.1%, 85.6%, and 94.3% preoperatively. 6 patients requested conversion to a duodenal switch during the follow-up period; all left the hospital in 4-6 days without major complication. CONCLUSIONS: Although the sleeve gastrectomy does not result in as much weight loss as the duodenal switch or gastric bypass, it can be used as a stand-alone operation or as a bridge to more complex procedures in the high-risk super-obese patient.

Adolescent↗
PubMedDate not supplied

[Causes of malnutrition in post-gastrectomy patient].

BACKGROUND: The stomach through its mechanical and chemical processes has an unique role in the food processing and bioavailability. Hence gastrectomy has predictable and modifiable nutritional consequences depending upon its knowledge and the post-surgery therapies. OBJECTIVE: To point out the impact of gastrectomy on the nutritional status focusing on both mechanical and chemical actions of stomach on intaked foods. RESULTS: The protein-energy malnutrition and consequent body-weight loss follow reversely the remainer gastric volume and post-operatory length and have anorexy and intestinal malabsorption as their main causes. Lower food intake is probably due to either emotional factors or chemical mediators acting centrally on hypothalamus. The diarrhea may be due to either increased peristalsis or bacterial overgrowth both aggravated by exocrine-pancreas deficiency and gallbladder overflow. The intestinal malabsorption leading to fecal losses of fat and or nitrogen as well as lower utilization of dietary calcium and liposoluble vitamins. The gastrectomy-related anemia is consequent to lower secretion of both HCl and intrinsic factor leading to a decreased solubilization of iron and lower absorption of vitamin B12, respectively. CONCLUSION: Body-weight loss and anemia are the protein-energy malnutrition findings often found in these patients whose severity and lasting depend upon the type of surgery, post-surgery length and received nutritional care, being strongly recommended a supervisioned dietary care.

Anemia↗
PubMed1976

Effect of total gastrectomy on acid proteolytic zymogens in serum and urine.

Proteolytic pH-activity curve and agar gel electrophoretic pattern of acid proteolytic zymogens in serum and urine were studied in totally gastrectomized patients. In serum, total gastrectomy was found to reduce proteolytic activity markedly, but no appreciable changes could be detected by electrophoretic analysis. In urine, however, in addition to the marked reduction of proteolytic activity, changes were found in electrophoretic pattern after total gastrectomy. Namely, fraction Pg 3 tended to persist, while Pg 5 disappeared along with the lapse of time after total gastrectomy. An unusual appearance of fraction Pg 7 in urine was also observed on the occasion of postoperative transient albuminuria. Their orgins and related clinical problems were discussed.

Albuminuria↗
PubMed1991

Gastric cancer following gastrectomy for benign gastroduodenal disease.

Twenty-four cases of resected remnant cancers following partial gastrectomy were retrospectively investigated for benign gastroduodenal disease. The time interval between the initial gastrectomy and the remnant gastrectomy was more than 10 years in 19 (79%) patients and less than 10 years in 5 (21%) patients. There were 2 cases with remnant cancer at stage I, 1 at stage II, 3 at stage III and 13 at stage IV for the all cases with a time interval of more than 10 years. Early-type remnant gastric cancer has a frequency of only 5%. The proportion of positive lymph node metastases was high, in 84%.

Aged↗
PubMed1991

Early gastric cancer following gastrojejunostomy without gastrectomy.

Two rare cases involving distal gastrectomies for gastric cancer after an earlier gastrojejunostomies without gastrectomy for duodenal or gastric stricture due to a duodenal or pre-pyloric ulcer are reported. The time interval between the initial gastrojejunostomy and the resection of the distal stomach with gastrojejunal stoma were 17 and 36 years. One patient underwent reconstruction by Billroth II and the other by Roux-en-Y end-to-side gastrojejunostomies, both retrocolically without any peri or postoperative complications. The histological classification was confirmed for both as type IIc mucosal early gastric cancer. Only 6 other primary early gastric cancers following gastrojejunostomies without gastrectomy have been reported in the Japanese literature.

Duodenal Ulcer↗
PubMed1980

The effect of glucose on plasma immunoreactive secretin in normal man and after gastrectomy or pancreatectomy.

Oral intake of glucose increased the peripheral plasma immunoreactive secretin (IRS) concentration in patients after total pancreatectomy with duodenectomy (p < 0.05) and in patients after total gastrectomy (p < 0.01). In young healthy volunteers and in patients after partial gastrectomy, no effect on IRS was observed. Intravenous glucose reduced the IRS concentration in pancreatectomized patients (p < 0.05), whereas IRS was only reduced in young healthy volunteers when intravenous glucose was followed by oral glucose after an interval of 10 min (p < 0.025). The abnormal IRS release in pancreatectomized patients and in patients after total gastrectomy might be due to rapid intestinal passage and/or increased splanchnic blood flow induced by hypertonic glucose. A third possibility is that a glucose-induced increase in bile flow might release IRS.

Administration, Oral↗
PubMed1986

The microflora of the gastric juice after Billroth I and Billroth II partial gastrectomy.

Detailed analyses of biochemical and microbiological variables such as pH, nitrite concentration, total viable counts (TVC), nitrate reductase-positive bacterial counts (NRPBC), and identification of microorganisms were carried out on 76 fasting gastric juice samples obtained at endoscopy from 64 patients previously submitted to partial gastrectomy (22 end-to-end Billroth I, 42 Billroth II/Reichel-Polya) and from 12 normal controls. Samples from normal controls were sterile, but bacteria were detected in the juice from all the operated patients. Significantly higher mean pH values and nitrite levels (p less than 0.001) were found in partial gastrectomies than in normal controls. In relation to surgical methods, higher mean pH values (p less than 0.005), nitrite levels (p less than 0.01), TVC (p less than 0.01), and NRPBC (p less than 0.005) were observed in the juice of patients with Billroth II as compared with Billroth I gastrectomies. Anaerobic bacteria, typical of faecal flora, and particularly Escherichia coli (p less than 0.05) characterized Billroth II samples. All these data suggest that the presence of bacteria in the gastric juice of gastroresected patients can be considered a risk factor of gastric neoplasia and that the type of operation used for the reconstruction of digestive continuity may influence the magnitude of this risk.

Adult↗
PubMed1990

Effect of gastrectomy with either Roux-en-Y or Billroth II anastomosis on small-intestinal function.

This prospective study was undertaken in patients scheduled for gastrectomy for peptic ulcer disease to determine the effect of partial gastrectomy with either Roux-en-Y (n = 11) or Billroth II anastomosis (n = 11) on the function of the small intestine. Patients were studied before and at 6 months (blood and small-intestinal function tests) and at 24 months (blood tests) postoperatively. Median postoperative body weights at 6 months (70.5 kg; p less than 0.01) and 12 months (70.3 kg; NS) were lower than preoperatively (73.0 kg). Haemoglobin concentrations at 6 months (8.9 mM; p less than 0.01) and at 24 months (9.1 mM; p less than 0.05) were also significantly reduced compared with the preoperative value (9.5 mM). However, neither at 6 nor at 24 months postoperatively were there significant changes for serum iron, iron saturation, folic acid, vitamin B12, protein, albumin, alkaline phosphatase, and calcium concentrations. Whereas no significant deterioration of the absorption of D-xylose and vitamin B12 or of faecal fat excretion was observed, the orocoecal transit time was significantly shortened from 98 to 50 min (p less than 0.01), the expiratory hydrogen excretion after a 50-g oral glucose load was significantly increased from 8 to 54 ppm (p less than 0.01), as was indicanuria from 257 to 368 mumol/24 h (p less than 0.01). Apart from a lower serum iron concentration and iron saturation index in the Roux-en-Y patients 6 months postoperatively (p less than 0.05), no significant differences between the two types of anastomosis were observed. It is therefore concluded that both in patients with Roux-en-Y and in those with Billroth II anastomosis most abnormalities observed after gastrectomy are secondary to an accelerated small-intestinal transit.

Anastomosis, Roux-en-Y↗