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PubMedDate not supplied

[An antiperistaltic duodenojejunal pouch in the reconstruction of digestive transit after subtotal and total gastrectomy and in the postgastrectomy syndrome. Results].

The author presents the results of a new surgical technique for the reconstruction of the gastrointestinal tract after gastrectomy. It was utilized in 36 patients (ten with total, 16 with subtotal and seven with minimal radical gastrectomy and also three cases of post-gastrectomy syndrome). The initial methodology, using the lost tie (group striction (GST)) to the duodenojejunal reservoir was not successful since it showed recanalization and consequent refluxing esophagitis (55,5%). For that reason, we changed to a complete section of the intestinal loop (group section (GS)). The follow up period ranged from one to 49 months. The following complications were observed: incisional hernia, one case (GST); early postoperative period death (19th day), one case (GS); dumping syndrome, one case (GST); bilious vomiting, two cases (GS); diarrhea, four cases (one GST and three GS). Clinically, in the late follow up of patients without recurrency of neoplasia, 17 of them have gained weight, four have lost weight and two were unaltered. Laboratory tests such as amilasemia, hematologic, proteins and glycemia were favorable to the method. Postoperative function, studied roentgenologically, showed that the average time emptying of the remmant stomach was 115 minutes in the subtotal resections and 82 minutes in total resections. The filling of the reservoir by the barium solution ranged from 40 to 60%; this variation depended on whether the duodenum was in peristalsis or antiperistalsis. Late death occurred in 13 patients, none because of the proposed technique.

Duodenum↗
PubMed1982

Absorption of biliary cobalamin in baboons following total gastrectomy.

Absorption of radiolabeled cobalamin in baboons was assessed by whole body counting. Retention of biliary cobalamin and an aqueous solution of cyanocobalamin was measured in normal baboons and in baboons after total gastrectomy by using 57Co-labeled biliary cobalamin and 58C0-cyanocobalamin, with and without baboon gastric juice containing intrinsic factor. Radiolabeled biliary cobalamin was obtained by intravenous injection of 57Co-cyanocobalamin in baboons and collection of bile through a cannula placed in the common bile duct. Cobalamin absorption was not completely abolished by gastrectomy and biliary cobalamin was better retained than cyanocobalamin; intrinsic factor enhanced absorption of both forms. After gastrectomy there was steady depletion of liver and serum cobalamin levels, which ceased after a new equilibrium was reached between a progressively diminishing cobalamin loss and the impaired but significant residual level of absorption. These studies in the nonhuman primate provide further information concerning the enterohepatic circulation of cobalamin and suggest that the form of cobalamin in bile may be more readily absorbed than is cyanocobalamin or that bile itself may have an enhancing effect on cobalamin absorption. The data also suggest that physiologically significant amounts of cobalamin may be absorbed in the absence of a gastric source of intrinsic factor.

Absorption↗
PubMed1978

[Iron absorption after gastrectomy following oral application of tardyferon].

Iron absorption was studied in 35 volunteers following oral application of Tardyferon during 21 days. In 25 patients a total gastrectomy and in 5 patients a subtotal gastrectomy have been performed, whereas 5 persons served as controls. The following parameters have been determined: Serum iron, iron binding capacity, hemoglobin, hematocrit, red blood cells and reticulocytes. The following results were obtained: Serum iron is markedly reduced in the patients with total gastrectomy during the first postoperative year, increases steadily and reaches normal values after the third postoperative year. Following oral application of Tardyferon an improved absorption is observed during the postoperative course. Because of the excellent absorption of Tardyferon it can be recommended for the oral application during the first two postoperative years.

Adult↗
PubMedDate not supplied

[Acute cholecystitis without gallstones following gastrectomy. A report on two cases (author's transl)].

Two recent cases of acute cholecystitis without gallstones following gastrectomy are reported. Details of the cases are described and the rare nature of this postoperative complication emphasized. Clinical diagnosis is difficult and the cause of this complication is usually not ascertained. Cholecystectomy remain the basic treatment, of choice, but cholecystotomy or simple drainage may be the only possible therapy, and should be employed whenever necessary. Postoperative acute cholecystitis is rarely observed, is usually associated with gallstones, and occurs in patients with previously healthy gallbladders in only exceptional cases, usually following digestive tract operations (Thomoret and Bronstein, 9). The initial surgical intervention then involves the stomach, whether it be a gastrectomy or vagotomy (Champeau, Delattre, 2). Two recent cases of post-gastrectomy acute cholecystitis without gallstones led to a review of the published literature to determine the frequency of this complication, and an attempt to define its characteristics.

Acute Disease↗
PubMed1995

[Early and late outcome of gastrectomy de principe].

Presented is a survey of 10 years experience of "Gastrectomie de principe" in the treatment of gastric cancer performed in the Surgical Department of Fulda. 219 gastrectomies were analysed, all of which were combined with lymphadenectomy of compartment I and II. Splenectomy was performed in 91%. 20% of the patients were operated with an early cancer, 37% showed no lymph node involvement. The rate of complications due to surgery was 13%, in 5.5% of patients we saw an insufficiency of the anastomosis, causing lethal outcome in 40% of these cases. The overall hospital mortality was 5.5%. Survival rates depended strongly on lymph-node involvement. The highest 5-year-survival of nearly 90% was seen in patients with an intestinal carcinoma in tumor stage T1 N0 M0, the 5-year-survival of all patients with an early cancer was 82%. The overall 5-year-survival was 25%. Total gastrectomy as the standard operative procedure shows low mortality, good controllability of complications and is to be recommended as a sufficiently safe therapeutical concept in patients with gastric cancer.

Adult↗
PubMed1995

Mac-1 expression and superoxide generation of the peripheral polymorphonuclear leukocyte following gastrectomy and esophagectomy.

The aim of this study was to evaluate the characteristics of the polymorphonuclear leukocyte (PMN) function after surgical stress. We investigated Mac-1 expression and superoxide generation by peripheral PMNs and serum granulocyte-colony stimulating factor (G-CSF) concentrations in 15 patients who underwent either gastrectomy (n = 8) or esophagectomy (n = 7). The serum G-CSF rapidly increased within 24 hours after operation. The maximum levels of serum G-CSF in the cases of esophagectomy were about 5-8 fold those of gastrectomy, although the increases in PMN counts within 24 hours of esophagectomy were lower than those after gastrectomy. Mac-1 expression and superoxide generation by PMN counts and serum G-CSF. After esophagectomy, Mac-1 expression on peripheral PMNs remained elevated through the 7th day after operation, while superoxide generation by PMNs in response to PMA declined to below preoperative levels after the 3rd day. These results suggest that, after major surgery such as esophagectomy, there is a discrepancy between Mac-1 expression and superoxide generation by the peripheral PMN despite a high level of serum G-CSF.

Aged↗
PubMed1994

[Jejunum pouch after total gastrectomy--clinical and scintigraphic studies of function and quality of life].

The formation of a pouch is a surgical procedure to restore the lost of reservoir function after resection of the stomach. After total gastrectomy the intestinal passage can be reconstructed by a jejunal pouch performing a Siewert/Peiper esophagojejunoplication. Regarding the postoperative quality of life we supposed that there is an advantage for this reconstruction method compared to simple esophagojejunostomy. The following study investigated whether the pouch reconstruction by jejunoplication can develop a reservoir function and therefore a better clinical course compared to jejunostomy. Without evidence of a local recurrence after total gastrectomy 18 patients with and 18 without pouch reconstruction were evaluated by alimentary scintigraphy for at least 6 months after operation. Only patients were included with a tumor stage not exceeding T2 (UICC). The results of the transit times with a solid radioactively labelled test meal were correlated with the complaints and nutritional status of the patients, evaluated with a standardized questionary for creating an individual score note. The transit in a jejunal pouch follows a linear decreasing function and is significantly slower compared to the exponential passage of the jejunostomy. Both patterns remain still significantly accelerated compared to the physiological ranges of gastric emptying. Patients with a pouch judge their postoperative individual state better than patients with simple jejunostomy indicated with an on average symptom related score note better than 3. As long as the tumor stage is associated with a beneficial prognosis and the tumor localisation allows the reconstruction by an esophagojejunoplication the formation of a pouch after total gastrectomy is recommended because of an improved transit pattern and clinical course.

Adult↗
PubMed1995

Characteristics of distal partial gastrectomy patients with esophageal symptoms of duodenogastric reflux.

OBJECTIVES: Partial gastrectomy patients with anatomic alterations to the pylorus and acid secretion are excellent models for studying the controversial role of duodenogastric reflux in producing esophageal symptoms and esophagitis. METHODS: We studied 13 partial gastrectomy patients who had recent upper gastrointestinal endoscopies and chronic duodenogastric reflux symptoms. Simultaneously, acid and duodenogastric reflux were assessed by ambulatory 24-h esophageal pH and bilirubin monitoring. Abnormal values for both acid and bilirubin reflux were defined by previous studies of healthy volunteers from our laboratory. Symptoms were recorded and correlated with acid and duodenogastric reflux episodes. RESULTS: Mean percent time bilirubin reflux for the entire group was 26.8 +/- 7.2% (range 0.4-91.2%), whereas mean percent total acid reflux was 4.6 +/- 2.4% (range 0.0-26.1%). Ten (77%) patients had abnormal duodenogastric reflux, but three patients (23%) also had associated abnormal acid reflux. Only these three patients had esophagitis, two ulcerative and one Barrett's esophagus. A total of 75 symptoms (36 heartburn, 33 epigastric pains, three regurgitation, two nausea/vomiting, one abdominal distension) were reported; 65% were acid related. Of patients with heartburn and regurgitation, 97% were associated with acid reflux episodes. CONCLUSIONS: Although excessive amounts of duodenogastric reflux are common in partial gastrectomy patients, esophagitis and Barrett's esophagus are seen only in patients with concomitant acid reflux, and most esophageal symptoms are acid related. Therefore, acid rather than duodenogastric reflux is the main culprit in this syndrome and should be aggressively treated.

Adult↗
PubMedDate not supplied

There is no need for nasogastric decompression after partial gastrectomy with extensive lymphadenectomy.

OBJECTIVE: To find out if routine nasogastric tube decompression is necessary after radical gastrectomy with systematic extensive lymphadenectomy in patients with gastric cancer. DESIGN: Prospective randomised trial. SETTING: Surgical Department, Taichung Veterans General Hospital, Taiwan. SUBJECTS: 74 patients with gastric cancer including 11 with gastric outlet obstruction who underwent radical distal gastrectomy. INTERVENTIONS: After operation, 37 patients were randomised to receive nasogastric intubation and 37 not to have it. MAIN OUTCOME MEASURES: Morbidity, mortality, and speed of recovery. RESULTS: No patient died after operation. The groups were comparable for the day of starting oral diet, rate of reinsertion of nasogastric tube and morbidity. Patients who were not intubated mobilised more quickly, and spent less time in hospital. Only one of seven patients with gastric outlet obstruction who had not been intubated needed to be so. CONCLUSIONS: Routine postoperative nasogastric decompression is unnecessary after radical gastrectomy even in the presence of gastric outlet obstruction.

Adult↗
PubMed1994

Results of subtotal gastrectomy with complete dissection of the N2 lymph nodes preserving the spleen and pancreas in surgery for gastric cancer.

In radical resection for gastric cancer, dissection of the N2 lymph nodes is recommended, and total gastrectomy with splenectomy and distal pancreatectomy is sometimes necessary, even if the cancer is located in the middle part of the stomach. However, splenectomy affects the immunological status, and distal pancreatectomy induces diabetes mellitus. In 22 patients with macroscopic Stage II gastric cancer located in the middle part of the corpus, we performed a complete N2 lymph node dissection without splenectomy or pancreatectomy and preserving the short and splenic vessels. Of the 22 cases, 6 had early gastric cancer and 16 advanced cancer. Twenty cases underwent subtotal gastrectomy and 2 cases total gastrectomy. The average number of lymph nodes dissected was 39 (13-82), and 8 patients (36%) showed positive lymph node metastasis (N1(+) 2 cases, N2(+) 6 cases). Postoperative complications were observed in 4 patients (18%), one of whom died of an intraabdominal abscess; the others are alive with no recurrence. This operation is safe and rational, and is recommended mainly in patients with mid-stage gastric cancer located in the middle part of the corpus.

Adult↗
PubMed1994

[Cholelithiasis after total gastrectomy for gastric cancer].

AIM: To examine the incidence of cholelithiasis in patients after total gastrectomy for gastric cancer. PATIENTS AND METHODS: Patients operated for gastric cancer at our hospital were retrospectively studied. Criteria to be included in the study were: 1) Follow-up of more than 3 years, 2) Cholelithiasis excluded preoperatively by ultrasonography, 3) Ultrasonographic postoperative control once a year. RESULTS: Ten patients met the established criteria. Six of them developed biliary lithiasis, and four of them needed surgical treatment for biliary symptomatology. CONCLUSIONS: The incidence of cholelithiasis after total gastrectomy for gastric cancer is high, and surgical treatment is often necessary. However our data does not support prophylactic cholecystectomy in the course of total gastrectomy.

Adult↗
PubMed1993

The 13C-urea breath test--detection of Helicobacter pylori infection in patients with partial gastrectomy.

The 13C-urea breath test (13C-UBT) for diagnosis of Helicobacter pylori (Hp) infection was evaluated in 41 patients after partial gastrectomy and was used for determination of the Hp-prevalence after two different procedures of reconstruction of the gastrointestinal tract, i.e. Billroth's II operation and Roux-en-Y anastomosis. Breath samples were taken at various time points within 30 minutes after a motility inhibiting liquid test meal with citric acid followed by 75 mg of 13C-urea. The 13CO2/12CO2-ratio (delta-value) was measured using isotope ratio mass spectrometry and the recovery of tracer in the exhaled breath was calculated (UBT-value). In all patients and in the corresponding control groups comparison of established reference methods (culture, CLO test, and Fuchsin staining) with the 4 point breath analysis for detection of Hp was investigated. In patients with partial gastrectomy, the sensitivity of the 13C-UBT to detect the presence of Hp and the negative predictive values were 100%, whereas the specificity and the positive predictive values were about 80%. In patients without gastric surgery quality control parameters were not significantly different. Hp-prevalence in postoperative patients was about 45%. All results were independent of their expression either as delta-value or as UBT-value and were not significantly different between the patients with Billroth's II operation and the patients with Roux-en-Y anastomosis. In conclusion, the 13C-UBT is a suitable method for diagnosis and therapeutic monitoring of Hp-status in patients after partial gastrectomy.

Adult↗
PubMed1993

Extended total gastrectomy for carcinoma of the cardia.

Eighty-five patients with gastric carcinoma developing at or involving the cardia were operated on under a newly established principle to prevent a cancer-positive proximal margin. The choice of operative procedure, standard total gastrectomy or extended total gastrectomy, was determined by the degree of proximal extension of carcinoma as confirmed by preoperative examinations. The cancer-positive rate was decreased in this manner to 1.2% from the 13.8% of the controls operated on before the principle was established. Extended total gastrectomy without sternotomy should be used more frequently than that with sternotomy because of the technical advantages. Survival rates of the 85 patients were 48.3% at three years and 30.4% at five years after the operation, and were not significantly different from the controls. As post-operative survival rate is influenced by factors other than transmural extension of the tumor, this study should prompt us to focus on the problem of the proximal surgical margin in surgery for carcinoma of the gastric cardia.

Cardia↗
PubMed1995

[Prevalence of Helicobacter pylori infection in gastrectomy and vagotomy].

OBJECTIVE: To report the prevalence of Helicobacter pylori infection in patients undergoing gastrectomy or vagotomy plus pyloroplasty because of peptic ulcer disease. METHODS: Eighty-five patients were studied (mean age = 61 years; 85% males) who had undergone gastric surgery: Billroth I gastrectomy (n = 25), Billroth II (n = 51) and vagotomy plus pyloroplasty (n = 9). During endoscopy biopsy specimens were obtained from fundus and both sides of anastomosis for histological (hematoxylin-eosin) and microbiological (Gram stain and culture) investigations. RESULTS: The overall percentage of Helicobacter pylori infection was 43.6% (Billroth I = 40%; Billroth II = 37%; vagotomy = 89%) and no differences were observed between both types of surgical reconstruction. However, differences were indeed observed (p < 0.01) when comparing percentages of infection between patients undergoing gastrectomy and vagotomy. Among infected gastrectomized patients H. pylori was detected in fundus in 93% of cases, whereas the recovery rate from anastomotic mouth biopsies was only 72% (p < 0.05). CONCLUSIONS: The prevalence of H. pylori infection in gastrectomized patients (Billroth I and II) was low regarding the cause of surgery (peptic ulcer disease), and no differences were observed between both types of surgical reconstruction. The prevalence of infection after vagotomy and pyloroplasty was significantly higher. Among infected gastrectomized patients, H. pylori was detected more frequently in gastric fundus compared with biopsy specimens obtained from the anastomotic mouth.

Adult↗
PubMed1996

Relationship between gastroesophageal reflux and gastric emptying after distal gastrectomy.

OBJECTIVES: Our objective was to determine whether delayed gastric emptying contributes to gastroesophageal reflux after distal gastrectomy. METHODS: To study gastric emptying and gastroesophageal reflux, we used a tecnnetium-labeled mixed liquid and solid test meal in 46 distal gastrectomy patients (19 with reflux symptoms and 27 without) and in 10 controls. The relationship of reflux symptoms to gastric emptying and the correlation between gastric emptying and the scintigraphic reflux index were evaluated. RESULTS: The reflux index was significantly higher in the symptomatic group (9.76 +/- 5.64%) than in the asymptomatic group (4.45 +/- 2.70%). The gastric emptying half time was significantly longer in the symptomatic group (53.13 +/- 19.39 min) than in asymptomatic group (34.26 +/- 20.40 min) and in normal controls (27.31 +/- 4.60 min). There was a significant linear correlation between the scintigraphic reflux index and the gastric emptying half time (r = 0.505,p < 0.001). CONCLUSIONS: These findings suggest that scintigraphy is a reasonably accurate test for detecting gastroesophageal reflux and that delayed gastric emptying plays an important role in the development of reflux after distal gastrectomy.

Adult↗
PubMed1996

Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer.

Physical results after pylorus-preserving gastrectomy (PPG) with preservation of the vagus nerve were evaluated. The status of 15 patients with early gastric cancer after PPG was compared with that of 14 patients after distal gastrectomy (DG). The postoperative/preoperative body-weight ratio of the PPG group (0.99) was significantly greater than that of the DG group (0.92). Patients who had PPG had fewer postoperative abdominal symptoms than those who underwent DG. The gastric emptying pattern of patients who had a pylorus-preserving procedure was slower than that of those who had conventional gastrectomy, and more similar to the preoperative pattern. Contraction of the gallbladder after PPG was better than after DG. Gastroscopy revealed that the mucosa of the stomach remnant after PPG was less abnormal than after DG. In conclusion, PPG is a more physiological operation than conventional DG and should be applied in carefully selected cases of early gastric cancer.

Body Weight↗
PubMedDate not supplied

[Total gastrectomy for gastric neoplasms].

In spite of the decreasing incidence of gastric carcinoma, as it is reported in recent reports from the U.S.A., total gastrectomy and its surgical indications results and complications, focus the interest of surgeons. We analize 61 cases of total gastrectomy for carcinoma, treated in the years 1982-1992. Perioperative mortality and long term survival appear highly satisfactory, mainly if one considers that the site and extension of the neoplasms treated would have severely impaired the possibilities of cure or long term survival with surgery of lesser momentum. We believe that nowaday indications for total gastrectomy can be widened in the hope of improving results of gastric cancer surgery with no or little additional risk.

Adult↗
PubMedDate not supplied

[Critical evaluation of the reconstruction of the intestinal continuity after total gastrectomy by the Moricca technique].

The authors analyze a series of 48 total gastrectomies for gastric carcinomas performed between 1987 and 1994. Seven out of these 48 gastrectomies were performed adopting the double circuit esophagojejunoduodenal plasty according the procedure described in 1976 by Francesco Moricca. The double jejunal loop represents a sort of "digestive reservior" allowing to avoid the sensation of epigastric fullness after eating. Moreover, this technique permits a better absorption of the liquids and the partial mixing of the bolus with the bilio-pancreatic secretion stimulates the duodenal secretin and cholecystochinin release. The possibility of a "dumping syndrome" is diminished by the presence of the double possibility of diversion of the alimentary bolus. On the contrary the segment of jejunum transposed between the esophagus and duodenum is antiperistaltic and this fact can cause sometimes an esophagitis at the lower third of the esophagus due to the prolonged alkaline reflux. This study is aimed at verifying the entity and frequency of the esophagitic complication in patients who underwent a total gastrectomy and at analyzing the procedures adopted to cure this severe complication that seriously affects the wellness and the nutritional status of the gastrectomized patients.

Adult↗