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PubMed2005

Quick recovery of serum diamine oxidase activity in patients undergoing total gastrectomy by oral enteral nutrition.

BACKGROUND: Total parental nutrition (TPN) meets the metabolic needs of postoperative patients, but introduces potential complications, including intestinal mucosal atrophy. Surgical advances have increased the certainty of esophagoenteric anastomosis making early oral enteral feeding after surgery feasible. The objective of the current report is to compare the benefits of enteral nutrition (EN) and TPN in patients undergoing total gastrectomy for gastric cancer. METHODS: Forty-two patients who underwent total gastrectomy for gastric cancer were randomized to receive oral EN beginning on postoperative day (POD) 3 with peripheral supplements or TPN beginning on POD 3. Serum concentrations of albumin and retinol-binding protein (RBP) as nutritional parameters and diamine oxidase (DAO) activity, an enzyme reflecting mucosal integrity, were measured preoperatively and 1, 4, 7, and 14 days postoperatively and compared between the 2 groups. Complications, abdominal symptoms, duration of hospital stay, and treatment cost per hospitalization were also compared. RESULTS: Albumin and RBP concentrations changed little in either group. DAO activity decreased in both groups and recovered within 1 week in the EN group but not in the TPN group. Complications were similar in the 2 groups. Treatment cost was less and length of hospital stay was shorter in the EN group. CONCLUSIONS: EN is an efficient way to provide nutrition to patients and possibly prevent intestinal atrophy in the patient who must endure prolonged postoperative fasting. Compared to TPN, EN reduces treatment cost and hospital length-of-stay.

Adult↗
PubMed2004

Videolaparoscopic total and subtotal gastrectomy with extended lymph node dissection for gastric cancer.

BACKGROUND: Laparoscopic surgery has been used in the treatment of early gastric cancer with low mortality and morbidity and improvement in patient's quality of life. The purpose of the current study was to determine if these advantages persist after radical laparoscopic treatment of more advanced gastric cancer. METHODS: A retrospective review of 44 patients after laparoscopic surgery for gastric cancer was performed. RESULTS: Tumor stage was IA in 8 patients, IB in 12, II in 9, IIIA in 6, IIIB in 1, and IV in 8. Eight total and 36 subtotal R0 gastrectomies were performed (12 D(1) and 32 D(2)). The mean number of dissected lymph nodes was 38.1 +/- 21.5. Conversion rate was 7%. Operative mortality and morbidity were 7% and 12%, respectively. Three-year survival was 75%. CONCLUSIONS: Laparoscopic radical total or subtotal gastrectomy with extended lymphadenectomy for gastric cancer is a feasible, safe, and oncologically effective procedure.

Adenocarcinoma↗
PubMed2006

Dai-kenchu-to, a Chinese herbal medicine, improves stasis of patients with total gastrectomy and jejunal pouch interposition.

BACKGROUND: Intestinal motility after gastric surgery frequently is disturbed and results in postoperative intestinal symptoms and poor quality of life (QOL). The purpose of this study was to examine the effects of Dai-kenchu-to on intestinal motility and postoperative QOL of patients. METHODS: Seventeen patients who underwent total gastrectomy with jejunal pouch interposition for gastric cancer in the Department of Surgery of Osaka University Medical Hospital were enrolled. The patients were assigned randomly to the cross-over study with or without 15 g/d of Dai-kenchu-to. Questionnaires and emptying tests using (111)In-labeled liquid and (99m)Tc-labeled solid test meal were performed at the end of each treatment period. A manometric study was performed in 6 patients to measure contractile activity with or without Dai-kenchu-to. RESULTS: Stasis-related symptoms were reduced significantly by Dai-kenchu-to (P = .032). In the emptying test, Dai-kenchu-to accelerated emptying of both liquid (P < .01) and solid (P = .015) meals from the pouch. The pouch showed bursts of contractions, which were increased significantly by oral intake of Dai-kenchu-to (P = .028). CONCLUSIONS: Dai-kenchu-to increased intestinal motility and decreased postoperative symptoms of patients with total gastrectomy with jejunal pouch interposition.

Cross-Over Studies↗
PubMed2003

Different effect of antiulcer agents on rat cysteamine-induced duodenal ulcer after sialoadenectomy, but not gastrectomy.

The focus was on salivary glands in cysteamine-induced duodenal ulcer and the different effects of antiulcer agents on cysteamine-induced duodenal ulcer in sialoadenectomized but not gastrectomized rats. We tested antiulcer agents on cysteamine-induced duodenal ulcer in rats (agents/kg i.p.) simultaneously with cysteamine 400 mg/kg s.c., rat killed 24 h thereafter subjected to no surgery (normal), to gastrectomy (24 h before) or sialoadenectomy, acute (24 h before) or chronic (21 days before). (i) Ulcerogenesis: cysteamine-induced duodenal ulcer had the same severity and incidence in normal, gastrectomized or acutely or chronically sialoadenectomized rats. (ii) Antiulcer effect under normal conditions or following gastrectomy: in normal or gastrectomized rats all agents tested, gastric pentadecapeptide BPC 157 [currently in clinical trials for inflammatory bowel disease (PL-10, PLD-116, PL-14736, Pliva) (10.0 microg or 10.0 ng), ranitidine (10 mg), atropine (10 mg), omeprazole (10 mg)] inhibited cysteamine-induced duodenal ulcers, acting through gastric acid-independent mechanisms. Following sialoadenectomy, acute or chronic: ranitidine, omeprazole and atropine were completely ineffective, while pentadecapeptide BPC 157 could protect. Thus, we found that contrary to stomach, salivary glands are implicated in cytoprotective agent activity (standard agents were ineffective after sialoadenectomy). Also, gastric pentadecapeptide BPC 157 was consistently associated with a cytoprotective effect, suggesting a beneficial activity distinctive from that of H2-receptor blockers, proton-pump inhibitors and anticholinergics; but probably replacing missing salivary glands factors.

Animals↗
PubMed2005

Complications after proximal gastrectomy with jejunal pouch interposition: report of a case.

We report a rare case of proximal gastrectomy complication as a result of a severe dilatation of a jejunal pouch interposed for reconstruction. A 44-year-old man who had early gastric cancer underwent proximal gastrectomy with a jejunal pouch interposition at our department. Fourteen months after the procedure, he began to complain of left hypochondrial fullness and reflux symptoms. He had difficulty eating and his quality of life (QOL) was markedly impaired. Barium meal revealed severe dilatation of the jejunal pouch. Decompression using a stomach tube and other measures only achieved temporary improvement. 4.5 years later, the dilated jejunal pouch was resected together with apyloroplasty and double tract reconstruction. Six months after this secondary surgery, the patient recorded no further complications. Food intake increased and QOL improved.

Adult↗
PubMedDate not supplied

Effects of preceding gastrectomy on the outcome of pancreatoduodenectomy.

It is a complicated task to perform pancreatoduodenectomy for patients who previously had undergone gastrectomy. This paper reviewed our experience of eight pancreatoduodenectomies in gastrectomized patients. The indications for gastrectomy included gastric cancer in 3 patients, duodenal ulcer in 1 patient, and gastric ulcer in 4 patients. The interval between the two operations ranged from 15-254 months (average: 103 months). All patients underwent pancreatoduodenectomy, and the reconstruction after pancreatoduodenectomy was performed by the Whipple method, the Child method, or other complex Roux-en-Y type methods. All the patients recovered and were discharged without gastrointestinal disorder. The results suggest that the secondary pancreatoduodenectomy does not increase the mortality rate, although we should use the jejunal limb with less tissue damage at the anastomotic site of which circulation is well maintained for choledochojejunostomy and pancreaticojejunostomy. Furthermore, the jejunal limb should be lined carefully to avoid intestinal kinking and excess tension to the anastomosis.

Adult↗
PubMed2006

Laparoscopy-assisted pylorus-preserving gastrectomy with quality controlled lymph node dissection in gastric cancer operation.

BACKGROUND: Pylorus-preserving gastrectomy (PPG) with extensive lymph node dissection is useful for treatment of early gastric cancer with preservation of function. This technique could be improved by using laparoscopy-assisted gastrectomy. STUDY DESIGN: Between September 2000 and September 2004, 109 patients with T1 gastric cancer underwent surgical treatment; 72 underwent laparoscopy-assisted PPG (LAPPG) and 37 underwent conventional PPG (CPPG). Total numbers of dissected lymph nodes, retrieval at each lymph node station, intraoperative blood loss, and operation times were used as measures of the quality of lymph node dissection to compare the procedures. Continuous data are summarized as mean +/- SE. RESULTS: Operation times with the LAPPG procedure (279 +/- 6 minutes) were significantly, but only 20 minutes, longer than with CPPG (259 +/- 8 minutes) (p = 0.047), although estimated blood loss for LAPPG patients (153 +/- 13 mL) was not significantly different for those undergoing CPPG (184 +/- 13 mL, p = 0.13). Mean total number of dissected lymph nodes was 32.3 +/- 1.6 in the LAPPG group and 28.5 +/- 2.2 in the CPPG group (p = 0.16). There was no significant difference in the number of lymph nodes retrieved for any of the nodal stations between the LAPPG and CPPG procedures. CONCLUSIONS: Clinical outcomes of surgical treatment were comparable for gastric cancer patients who underwent LAPPG and those treated with CPPG in terms of station-dependent lymph node dissection and estimated blood loss.

Adenocarcinoma↗
PubMed2006

Motility of the pouch correlates with quality of life after total gastrectomy.

BACKGROUND: Jejunal pouch reconstruction is used to provide reservoir function after total gastrectomy, but controversy remains regarding pouch functions and quality of life (QOL). In this study, pouch motility was studied in conjunction with postoperative QOL. METHODS: Pouch motility of 23 patients with jejunal pouch interposition after total gastrectomy was examined by manometry under fasting conditions and by an emptying test using dual-scintigraphy under postprandial conditions. Residual food was graded by endoscopic examinations. QOL was evaluated using the Gastrointestinal Quality of Life Index, and a stasis- or dumping-related symptom score. RESULTS: The pouch showed interdigestive contractile activity. Bursts of contractile activity occurred frequently and were long-lasting compared with the migrating motor complex phase III of the control jejunum. The percentage of time of contractile bursts correlated with postprandial pouch emptying (liquid: R(2) = 0.229, P < .03; solid: R(2) = 0.243, P < .02). Patients with little or no residual food had more percentage of time of contractile bursts than those with moderate residual food (P < .01). The percentage of time of contractile bursts was correlated with the Gastrointestinal Quality of Life Index score (R(2) = 0.262, P < .02), stasis-related symptoms (R(2) = 0.279, P < .01), and dumping-related symptoms (R(2) = 0.218, P < .03). CONCLUSIONS: An interposed jejunum pouch showed bursts of contractile activity that affected postoperative gastrointestinal function and patient QOL.

Duodenum↗
PubMed2000

Simple versus double jejunal pouch for reconstruction after total gastrectomy.

BACKGROUND: Even though many types of reconstruction after total gastrectomy have been proposed to reduce postgastrectomy syndromes, choosing a method that would further improve the quality of life and nutrition of the gastrectomized patient is controversial. Hunt-Lawrence single pouch reconstruction seems to obtain better results compared with the more common Roux-en-Y technique, but both of these reconstructive approaches are associated with some reduction in food intake and some problems in achievement of ideal body weight. METHODS: In this prospective, randomized trial, after total gastrectomy 18 patients had reconstruction according to the Hunt-Lawrence or single pouch technique (SP group), whereas for 23 patients, the technique was modified with construction of a second pouch in the distal portion of the jejunal loop (DP group). Patients in the two groups were compared at 12 months after surgery for problems in gastrointestinal function, quality of life, improvement in body weight and nutritional parameters, serum albumin, hemoglobin level, and serum protein. RESULTS: The DP group demonstrated fewer symptom problems, better weight maintenance, and better laboratory values when compared with patients undergoing standard single jejunal pouch reconstruction. CONCLUSIONS: Reconstruction with use of a double pouch as a gastric substitute leads to better outcome assessments than with a single pouch reconstruction. Our double pouch technique has demonstrated significant improvement in quality of life and nutritional recovery in terms of functional results as well as patient satisfaction.

Aged↗
PubMed2001

A new technique for esophagojejunostomy after total gastrectomy for gastric cancer.

BACKGROUND: The critical part of any operation involving a proximal gastric resection is the esophageal anastomosis. Leakage from this anastomosis is one of the main reasons for postoperative morbidity and death after gastrectomy. Application of the double-stapling technique affords many of the same advantages that it does for low rectal tumors, especially in obese patients with narrow costal margins. METHODS: A new technique for esophagojejunostomy after total gastrectomy for gastric cancer is described. RESULTS: This technique has been used in 3 patients. At a follow-up of 22 months, there have been no anastomotic leaks or evidence of clinical stenoses. CONCLUSIONS: This technique minimizes manipulation and dissection around the distal esophagus. Not only does this make the operation easier, but it also allows for a longer proximal resection margin. Possibly this will result in lower rates of esophageal breakdown.

Equipment Design↗
PubMed2002

Linear stapling forms improved anastomoses during esophagojejunostomy after a total gastrectomy.

BACKGROUND: Circular stapling devices are commonly used to form esophagojejunal anastomoses after total gastrectomy. However, the technique has potential problems with placement of the purse-string suture and insertion of the anvil of the instrument. METHODS: We describe an improved technique for esophagojejunostomy by functional end-to-end anastomosis with linear stapling devices. RESULTS: Three patients with gastric cancer underwent this procedure after total gastrectomy. No anastomotic leakage or clinical evidence of stenosis was encountered. The maximum diameters of the anastomoses, evaluated by radiography with barium at 6 months after surgery, were 3.5 cm and 4.0 cm in 2 patients. Endoscopic examination revealed clear lines of anastomosis with a straight continuity between the distal esophagus and the jejunum. CONCLUSIONS: Our improved technique for esophagojejunostomy by functional end-to-end anastomosis with two linear staplers is a convenient, safe and reliable procedure that is independent of the width of the esophagus and the depth of the esophageal hiatus.

Anastomosis, Surgical↗
PubMed2003

Studies on gastrointestinal hormone and jejunal interdigestive migrating motor complex in patients with or without early dumping syndrome after total gastrectomy with Roux-en-Y reconstruction for early gastric cancer.

BACKGROUND: There has been no report concerning fasting Roux limb motilities and gut hormone in patients with early dumping syndrome (EDS) after total gastrectomy with Roux-en-Y reconstruction. The present study investigated interdigestive migrating motor complex, phase III (IMMC-pIII) in the Roux limb, changes in the plasma gut hormone levels, and the relationships among those parameters and EDS. METHODS: Forty-eight patients (35 men, 13 women; aged 33 to 69 years, mean, 59.8) 1.5 to 2.0 years (mean 1 year, 8 months) after total gastrectomy with Roux-en-Y reconstruction for early gastric cancer were allocated to two groups based on the presence or absence of EDS. The occurrence of IMMC-pIII was compared and changes in the plasma levels of both motilin (MT) and somatostatin (SOM) were monitored. RESULTS: None of the patients with EDS (n = 8) were recognized as having IMMC-pIII. In the IMMC-pIII positive group, MT and SOM increased sequentially from phase I through IMMC-pIII. In the IMMC-pIII negative group, MT and SOM were significantly lower than in the IMMC-pIII positive group during phases I, II, and IMMC-pIII (P <0.05, P <0.01, P <0.01, respectively). CONCLUSIONS: There is an absence of IMMC-pIII in patients with EDS, and both MT and SOM might be necessary for IMMC-pIII generation.

Adult↗
PubMed1995

Early clinical results with the uncut Roux reconstruction after gastrectomy: limitations of the stapling technique.

BACKGROUND: The aim of this study was to review our early clinical experience with the uncut Roux gastrectomy, a modified Billroth II gastrojejunostomy in which four rows of staples occlude the afferent jejunal lumen, while biliary and pancreatic secretions are diverted distally through a jejunojejunostomy. METHODS: Between September 1991 and April 1993, 9 women and 5 men underwent uncut Roux gastrectomy for gastric adenocarcinoma (5), postvagotomy or idiopathic gastroparesis (7), Roux stasis syndrome (1) or anastomotic ulceration with gastric outlet obstruction (1). Subsequently, patients were seen or contacted by phone within the 6 months prior to March 1994. RESULTS: Eight of the 14 patients (57%) had excellent results with stable weight and no nausea, vomiting, heartburn, abdominal pain, or postprandial symptoms. One patient continued to have early satiety and vomiting but maintained stable weight for 19 months postoperatively. Five patients (36%) had poor results with alkaline reflux gastritis or esophagitis. All 5 had documented staple line dehiscence. Four of them were reoperated on and converted to a standard Roux operation with relief of symptoms. CONCLUSIONS: The uncut Roux operation prevents the Roux stasis syndrome, but the current technique has an unacceptably high incidence of dehiscence of the staple lines with subsequent reflux gastritis or esophagitis.

Adult↗
PubMed2002

Defects in mandibular bone area, enamel iron content and dentine formation following gastrectomy in rats.

Fourteen 5-week-old male Sprague-Dawley rats were equally divided into two groups, sham-operated and gastrectomized. Tetracycline and calcein were given to label dentine. Four weeks after surgery, blood was collected for measurement of serum iron, calcium and parathyroid hormone (PTH) and the mandibles and maxillae were then removed. Sagittal sections of the maxilla or cross-sections of the mandible were prepared and examined. Backscattered electron images of the maxilla were taken and the iron content at the neck of incisors was measured by energy-dispersive X-ray. The dentine apposition rate in maxillary incisors was measured by fluorescence microscopy. Serum iron was significantly decreased, while PTH was significantly elevated without any change in the serum calcium in gastrectomized rats. Gastrectomy caused a gross loss of iron content in superficial enamel. The dentine apposition rate was significantly reduced by 30%. Both cortical and cancellous bone in the mandibula were significantly reduced. However, the total bone area in gastrectomized rats was similar to that in sham-operated rats. These results suggest that bone resorption was enhanced and dentine formation was reduced after gastrectomy.

Anemia, Iron-Deficiency↗
PubMed1999

Subtotal gastrectomy in a teenager with gastroparesis.

Disorders of gastric emptying are rare in healthy infants and children. Delayed gastric emptying is encountered in adults after operations on the stomach, such as vagotomy and partial gastrectomy, and is extremely rare in young patients. The authors report on a 15-year-old patient with gastroparesis after three attempts to repair a congenital diaphragmatic hernia. Medical therapeutic trials consisting of all combinations of diet regimes with various gastrokinetic drugs failed to alleviate the intractable vomiting. All the patient's symptoms resolved after subtotal gastrectomy with gastroduodenostomy (Billroth I).

Adolescent↗
PubMed1987

Total gastrectomy for benign disease.

Among 37 patients who underwent total gastrectomy for nonmalignant disease, operative mortality was 4 per cent after 27 elective operations and 10 per cent after 10 emergency operations. Three other patients died 1 to 6 months after operation. Major postoperative complications occurred in 24 per cent. Long-term follow-up of 26 patients (81 per cent of survivors) after a mean +/- SEM of 8.4 +/- 1.1 years showed that 73 per cent of patients had no or only occasional, easily controlled, mild abdominal symptoms and good enough health to enable them to work or carry out normal activities for their age. The patients lost a mean of 15 per cent of their body weight, however, and about one third of them had weakness and diarrhea. A quarter of them had anemia despite iron and vitamin B12 therapy. Our conclusion was that total gastrectomy is a reasonable operation for benign diseases. Nonetheless, in view of the substantial postoperative mortality and morbidity, the operation should be used only when less extensive operations will not suffice.

Adult↗
PubMed1977

Mucosal changes in the gastric stump 20-25 years after partial gastrectomy.

Out of 421 patients who had partial gastrectomy 20-25 years ago for gastric or duodenal ulcer, 108 were examined by endoscopy with multiple biopsy. In no case were the endoscopic appearances of the mucosae interpreted as malignant, though in 2 patients the clinical history suggest malignant disease. Histological examination revealed infiltrating carcinoma in 4 patients, 3 of whom had intramucosal carcinoma only. 3 further patients had severe dysplasia (carcinoma-in-situ). Only 1 patient had a near-normal mucosa close to the anastomosis; in the remainder the gastric remnant showed various degress of dysplasia, metaplasia, or chronic atrophic gastritis. In the patients with carcinoma only 28 (12%) of the 226 biopsy specimens revealed the malignant lesion. Patients who have had partial gastrectomy for benign lesions are at high risk of gastric-stump carcinoma. If, 20 years after operation, they have an endoscopy with multiple biopsy, stump carcinoma may be detected early when the prognosis after operation is probably good.

Adult↗
PubMed1980

Anaemia after partial gastrectomy: a neglected curable condition.

Anaemia is a well recognised complication of partial gastrectomy, the incidence increasing with the postoperative interval. Many surveys show a similar incidence of untreated anaemia, which implies that the need for regular follow-up is recognised but not put into practice. Much information is available on the aetiology of postgastrectomy anaemia, and a single course of therapy is known to be effective. Since the difficulty semms to lie in early detection, prophylaxis may be a solution. Our study of a group of patients treated by gastrectomy attending a follow-up clinic during the past ten years has provided information on the frequency of anaemia and the outcome of different treatments.

Anemia, Hypochromic↗