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PubMed1994

[Experimental study on intestinal movement after total gastrectomy with jejunal interposition].

In order to study the physiological changes in the intestinal movement after total gastrectomy with jejunal interposition, electromyography was taken from different sites of small intestine of the dogs with and without gastrectomy. Both 6 and 12 months after surgery, the frequency of the basic electric rhythm (BER) of interposed jejunum was lower and that of distal jejunum was much lower than that of duodenum. Most of the interdigestive migrating electric complexes (IMEC) was originated in the oral side of the interposed jejunum; the rate of occurrence increased after the operation further and reached to 91.5% one year after the operation. Most of the dogs showed the propagation pattern from interposed jejunum to duodenum and to distal jejunum; this tendency increased after the operation and 80.8% of the dogs showed this pattern one year after the operation. Thus, the IMEC, conducted usual intestinal order disappeared after the operation and those originated from oral to anal side, regardless of their original order. These results suggest that the order of the propagation of IMEC were determined by the order of the portion of intestine after operation and the parietal continuity, rather than extrinsic nerves, is involved in the propagation. It is also suggested that the propagation of IMEC is not always correlated with the gradient in the difference of the BER between the replaced jejunum and duodenum.

Action Potentials↗

PubMed1976

[Electromyographic studies on gastric and intestinal motor function following pylorus preserving gastrectomy with jejunal interposition in dogs (author's transl)].

The gastric and intestinal motor function following pylorus preserving gastrectomy with jejunal interposition were studied electromyographically in dogs. The action potentials were recorded from the interposed jejunal segment, the preserving pylorus and the duodenum before and after insertion of warm water. Studies were made on the frequency, the propagation velocity of the spike-bursts in the portions mentioned above, and the incidence of the spike-bursts which propagated from the distal porition of the interposed jejunal segment to the preserving pylorus, and from the preserving pylorus to the proximal portion of the duodenum. The results obtained are as follows: 1) The frequency of the spike-bursts found in the interposed jejunal segment, the preserving pylorus, and the duodenum showed a remarkable increase after insertion of warm water. 2) The propagation velocity of the spike-bursts in the interposed jejunal segment, the preserving pylorus, and the duodenum were accelerated after insertion of warm water. 3) There were observed a moderate increase in the incidence of the spike-bursts which propagated from the distal portion of the interposed jejunal segment to the preserving pylorus, and from the preserving pylorus to the proximal portion of the duodenum after insertion of warm water. These findings suggested that the motor function of the interposed jejunal segment, that of the preserving pylorus, and that of the duodenum after pylorus preserving gastrectomy with jejunal interposition might be kept not yet injured enough to transport the contents from the interposed jejunal segment into the duodenum.

Action Potentials↗

PubMed1978

[Electromyographical study on the residual stomach following proximal gastrectomy (author's transl)].

The role of the antral gastric vagi and the pyloric sphincter on the residual stomach following proximal gastrectomy were studied electromyographically, using adult mongrel dogs. At the first stage of surgery, proximal gastrectomy was performed preserving the bilateral antral gastric vagi followed by esophagogastrostomy by end-to-side anastomosis. The residual stomach was equipped with four bipolar silver needle electrodes and two waterproof strain gauges on the wall of the stomach. At the second and third stage of surgery, the same dog subsequently underwent trancal vagotomy and pyloromyotomy at 4 weeks intervals. Following proximal vagotomy, the interval of the BER in fasting was prolonged. Dysrhythmia was observed quite frequently, and the amplitude and rhythmicity of contractile activities of the residual stomach became lowered and distorted, however, after feeding the interval of the EBR was shortened and dysrhythmia was altered to a regular rhythmic pattern. Frequent episodes of vomiting were observed following over feeding. Subsequent trancal vagotomy showed increased incidence of dysrhythmia in fasting, and gave no favourable effects on the vomiting episodes or the amount of feeding. After pyloromyotomy, the amount of feeding could be increased by about 50% from the original optimal amount.

Animals↗

PubMed1988

[The effect of vagotomy and gastrectomy on the lower esophageal sphincter motility].

The motor activity of the canine lower esophageal sphincter (LES) was studied under conscious states by means of the strain gage transducer, and gastroesophageal reflux was investigated after injection of the contrast medium through the silastic tube inserted in gastric fundus by x-ray. The motor activity and function of LES were observed in the dogs with selective proximal vagotomy (SPV), truncal vagotomy (TV) and TV + gastrectomy. Results were summarized as follows; 1. In the postprandial period, so called receptive relaxation was observed in gastric body, and tonic contraction was observed in LES. On the other hand, the occurrence of the LES contraction was consistent with gastric periodic motor activity in the interdigestive state. It was found that such a contractile pattern of LES and gastric body prevented the reflux of gastric juice from stomach to esophagus in the digestive and interdigestive state. 2. In the postprandial period, the tonic contraction of LES was inhibited by the venous injection of atropine sulfate. Mechanisms of digestive contractile activity of LES were mainly regulated by cholinergic nerve. 3. After SPV and TV, the motility of LES and gastric body was disturbed. Namely, receptive relaxation disappeared, and tonic contraction was observed in gastric body, but the relaxation of the LES was found after ingestion. These findings suggested that discordant LES contractiles with the contraction of the gastric body after vagotomy produced a gastroesophageal reflux. 4. After TV + gastrectomy, the synchronous motor activity of the LES, remnant stomach and duodenum disappeared. Namely, it was thought that the reflux esophagitis occurred after gastric surgery with vagotomy and lymphnodes dissection was caused by the duodenal juice reflux to remnant stomach and esophagus.

Animals↗

PubMedDate not supplied

Fatal pulmonary thromboembolism in gastrectomy intraoperative procedures by gastric adenocarcinoma: case report.

The case of a patient with gastric adenocarcinoma with indication for gastrectomy is reported. The surgery took place without complications. A palliative, subtotal gastrectomy was performed after para-aortic lymph nodes compromised by neoplasm were found, which was confirmed by pathological exam of frozen sections carried out during the intervention. At the end of the gastroenteroanastomosis procedure, the patient began to show intense bradycardia: 38 beats per minute (bpm), arterial hypotension, changes in the electrocardiogram's waveform (upper unlevelling of segment ST), and cardiac arrest. Resuscitation maneuvers were performed with temporary success. Subsequently, the patient had another circulatory breakdown and again was recovered. Finally, the third cardiac arrest proved to be irreversible, and the intra-operative death occurred. Necropsy showed massive pulmonary embolism. The medical literature has recommended heparinization of patients, in an attempt to avoid pulmonary thromboembolism following major surgical interventions. However, in the present case, heparinization would have been insufficient to prevent death. This case indicates that it is necessary to develop preoperative propedeutics for diagnosing the presence of venous thrombi with potential to migrate, causing pulmonary thromboembolism (PTE). If such thrombi could be detected, preventative measures, such as filter installation in the Cava vein could be undertaken.

Adenocarcinoma↗

PubMed2005

Total gastrectomy with substitution of stomach by jejunal pouch with and without duodenal passage. Study in rats.

PURPOSE: A comparison was done between the F. Paulino jejunal pouch (FP) and a jejunal pouch (JP) as esophagus-duodenum interpositional graft, for replacing the stomach after total gastrectomy. It was investigated the effect of the two procedures on esophagus histology, nutritional state and serum gastrin in rats. METHODS: Male Wistar rats weighing 282 +/- 17g were randomly submitted to sham operation (S), FP and JP after total gastrectomy. After eight weeks the rats were killed with overdose of anesthetic and tissue was taken from the distal esophagus for histology. Serum levels of total proteins, albumin, iron, transferring, folate, cobalamine, calcium, as well as serum gastrin were determined. Survival was considered. RESULTS: Fourty six rats were operated and thirty survived for eight weeks. Five (33.3%) died after FP and 11 (52.3%) after JP (p < 0.05). Postoperative esophagitis occurred in 6 JP rats. At 8th week, no difference was observed on body weight when compared FP and JP rats (p > 0.05). The JP rats had a significant decrease in serum albumin, glucose, transferrin, iron, folate and calcium, compared to sham (p < 0.05). Serum gastrin, iron and calcium were significantly higher in JP rats than in FP rats (p < 0.05). In FP rats, transferrin and cobalamine showed significant decrease comparing the preoperative with 8th week levels (p < 0.05). CONCLUSION: F. Paulino pouch in rats had lower mortality than JP, and esophagitis was not detected in it. JP rats had serum gastrin, iron and calcium unaffected, possibly because of preservation of duodenal passage.

Analysis of Variance↗

PubMed1996

Pancreaticogastrostomy: effect of partial gastrectomy on the pancreatic stump in rabbits.

To assess the influence of digestive juice on the pancreatic stump when pancreaticogastrostomy was performed after pancreatoduodenectomy, the pancreatic stump was anastomosed to the intact stomach (group I), the stomach after partial gastrectomy (group II), or the jejunum (group III) in rabbits, and the nature of the digestive juice at the anastomotic site as well as the histologic changes of the pancreatic tissue were investigated. The digestive juice was highly acidic in group I, slightly acidic in group II, and almost neutral in group III. Histological examination of the pancreatic stump revealed extensive coagulative necrosis and delayed replacement with granulation tissue in group I, while there was less prominent liquefactive necrosis and early replacement with granulation tissue in groups II and III. Intraperitoneal abscess formation around the anastomotic site and atrophic fibrosis of the pancreas (similar to the changes after pancreatic duct ligation) occurred in 27.8% and 46.2% of group I rabbits, respectively, but no such changes were detected in groups II and III (both P < 0.05). These results indicate that the highly acidic gastric juice had a widespread corrosive effect on the anastomosed pancreatic tissue, and that partial gastrectomy may be necessary to prevent anastomotic leakage and pancreatic duct obstruction after pancreaticogastrostomy.

Amylases↗

PubMed1978

Recurring hyperplastic gastric polyps following subtotal gastrectomy.

Mucosal polyps of the stomach are separated by histologic means into two major groups: (1) hyperplastic (or regenerative) polyps and (2) adenomas, including adenomatous polyps and villous adenoma. Hyperplastic polyps are not true neoplasms, but probably represent a reactive response to some form of mucosal injury. A little known but interesting manifestation of hyperplastic gastric polyps concerns their development, growth, and recurrence in the gastric remnant following subtotal gastrectomy. The clinical, radiologic, and pathologic findings in two cases of recurring symptomatic hyperplastic gastric polyps after subtotal gastrectomy are presented. It is proposed that reflux bile gastritis might have played an important etiologic role in the development of these recurring hyperplastic polyps.

Adult↗

PubMed2003

Usefulness of high-density barium for detection of leaks after esophagogastrectomy, total gastrectomy, and total laryngectomy.

OBJECTIVE: The purpose of this study was to determine the usefulness of a high-density (250% weight/volume) barium compared with a water-soluble contrast agent for the detection of esophageal leaks in patients who had undergone esophagogastrectomy, total gastrectomy, or total laryngectomy. MATERIALS AND METHODS: A search of our radiology database from 1998 to 2001 revealed 46 eligible radiographic studies performed using a water-soluble contrast agent alone or a water-soluble contrast agent followed by barium that showed leaks in patients who had undergone esophagogastrectomy, total gastrectomy, or total laryngectomy. The images were reviewed to determine the morphology of the leaks (i.e., blind-ending tracks, sealed-off collections, or free extravasation of contrast material). Medical records were also reviewed to determine whether detection of the leaks seen on the radiographic studies affected patient management. RESULTS: Of the 46 leaks seen on radiographic studies, 23 (50%) were detected with a water-soluble contrast agent and 23 (50%) were detected only with high-density barium. Of the 23 leaks visualized with water-soluble contrast media, six (26%) were characterized by blind-ending tracks, 14 (61%) by sealed-off collections, and three (13%) by free extravasation of contrast material into the mediastinum or neck. Of the 23 leaks visualized only with high-density barium, 19 (83%) were characterized by blind-ending tracks and four (17%) by sealed-off collections. Thus, leaks detected only on images obtained with high-density barium were significantly more likely to be characterized by blind-ending tracks than those detected on images obtained with a water-soluble contrast agent (p = 0.0007). Of the 33 patients with clinical follow-up, the findings seen on these imaging studies affected management in 12 (86%) of 14 patients with leaks depicted by water-soluble contrast media and in 10 (53%) of 19 with leaks depicted only by high-density barium. CONCLUSION: Our findings support the use of high-density barium as part of the routine postoperative radiographic examination when no leaks are detected on images obtained with a water-soluble contrast agent.

Adult↗

PubMed1994

Total gastrectomy for gastric cancer: 12-year data and review of the effect of performing lymphadenectomy.

A total of 1,272 patients with gastric cancer were admitted to our institute for surgery during 12 years (1975-1986). Of these, 1,059 (83.4%) underwent gastrectomy. Among these, 252 (23.8%) were total gastrectomy (TG), involving 160 (63.5%) cases of cancer mainly located in the upper third of the stomach, 81 (32.1%) in the middle third and 11 (4.4%) in the lower third. Radical TG was performed in 65.9% and palliative TG in 34.1%. Roux-en-Y reconstruction was selected in 80%, jejunal interposition in 17.6% and double tract in 2.4%. The survival rate was improved by introducing extended lymph node dissection, especially in the cases of stage III & IV cancer in which a combined pancreatico-splenectomy could lead to cure when associated with lymphadenectomy. In cases of a positive serosal exposure, the 5-year survival rate was increased by extended lymphadenectomy from 21% to 46% (p < 0.02). Anastomotic leakage occurred in 4.2%. The postoperative mortality rate was 1.6%, occurring in only 4 patients.

Adenocarcinoma↗

PubMed1999

Histopathological findings of the lower esophagus after total gastrectomy in rat.

It is now accepted that the incidence of esophageal carcinoma is highest in the middle thoracic region. Esophageal carcinoma after gastrectomy, however, has a tendency to develop in the lower region. This study was designed to investigate the role of reflux of gastroduodenal juice in the genesis of carcinoma in the esophagus. We found a possible correlation between the development of esophageal carcinoma and gastrectomy, related to alkaline reflux into the esophagus. To elucidate this correlation, the role of alkaline reflux of duodenal contents in the development of esophageal squamous cell carcinoma was investigated in Wister rats. Gastrectomized rats with regurgitation of duodenal contents into the esophagus were not administered any carcinogen and were sacrificed some at the end of 8 weeks and others at 50 weeks for pathological examination. Hyperplasia was found in rats at 8 weeks, and the esophageal squamous cell carcinoma was found in rats at 50 weeks. The carcinomas were found exclusively in the area of the reflux esophagitis and were accompanied by severe dysplasia. These results suggested that alkaline reflux of duodenal contents was strongly correlated to the development of the esophageal squamous cell carcinoma.

Animals↗

PubMed1982

The intramucosal cysts of the stomach. II. Late glandular changes after partial gastrectomy.

Micrometric determinations of the diameter of the gastric glands, of the linear distance between those glands, and of the number of chronic inflammatory cells were performed on gastric biopsies from 71 patients. Forty of the patients had been operated on with a Billroth II and 12 with a Billroth I gastrectomy 5-45 years previously. The mean diameter of the gastric glands was significantly larger for patients with a Billroth II gastrectomy than for those of the Billroth I group or for non-operated control patients with chronic gastritis. The difference was marked for Billroth II patients operated on 26 or more years previously. Contrariwise, the linear distance between glands was significantly smaller in Billroth II patients than in the other two groups. The number of inflammatory cells was somewhat lower in biopsies from operated patients than in controls. The significance and pathogenesis of dilated gastric glands in long-time Billroth-II-gastrectomized patients (a high-risk group for cancer development in the gastric stump) is discussed.

Biopsy↗

PubMed1995

Carcinogenesis after remote peptic ulcer surgery: the long-term prognosis of partial gastrectomy.

Remote partial gastrectomy for benign disease is a premalignant condition. The overall risk of gastric stump cancer is approximately a twofold increase, but patients more than 20-25 years postoperatively may have a four- to fivefold increased risk, compared to the age- and sex-matched general population. The duration of postoperative interval is the most important risk factor. For the first 10 years after initial surgery, gastric cancer risk may be reduced due to the removal of the most cancer-prone distal part of the stomach, but thereafter there is a rapid increase of the relative risk. The etiology and precise mechanism of carcinogenesis is unknown, but the time relationship with surgery suggests that the anatomical alterations induced by the operation must be important. Hypochlorhydria, reflux, diminished gastrin production, bacterial proliferation, and nitrosation are the putative contributing factors. In addition, smoking appears to contribute to a generalized cancer mortality and decreased life expectancy after peptic ulcer surgery. Digestive tract cancers other than the gastric ones which show an increased risk after peptic ulcer surgery are pancreatic and biliary tract cancers. Premalignant and precursor lesions occur more frequently in the gastric remnant after peptic ulcer surgery and endoscopic bioptic screening can detect early stump cancers at a curable stage. Large-scale screening programs of post-gastrectomy patients are nevertheless not recommended, and surveillance appears not justified.

Follow-Up Studies↗

PubMed1992

[Stomal stenosis following gastrectomy in the elderly].

Seven hundred and thirty seven patients over 65 years of age (mean 76 years) undergoing gastrectomies from 1979 to 1991 were reviewed to evaluate the cause of stomal stenosis in the early postoperative period. Fifty seven (7.7%) patients, 24 males (5.6%) and 33 females (10.6%), had overt stomal stenosis or obstruction documented by radiological and endoscopic findings. The incidence of stenosis in females was significantly higher than in males (p < 0.05). Complications developed in 19 (20.0%) of 95 patients after gastroduodenostomy (Billroth-I), 29 (6.2%) of 465 after gastrojejunostomy (Billroth-II and others) and 8 (5.0%) of 159 after esophagojejunostomy (total gastrectomy). The incidence of complications in the first was significantly higher than in the other two (p < 0.01). The cause of stomal stenosis was classified into three groups; (1) transient stenosis due to stomal edema in 21 patients, (2) intestinal obstruction immediately adjacent to the stoma (kinking, invagination and volvulus) in 22, (3) organic stenosis of pathological origin (stomal ulcer, anastomotic leakage and strangulation by the proliferated mesocolon) in 14. The period of recovery from postgastrectomy retention was different in each group. It was 20.7 (mean) +/- 7.7 (SD) days in group (1), 29.7 +/- 12.6 days in group (2) and 62.1 +/- 30.0 days in group (3). These mean periods were significantly different from each other (p < 0.01). Group (1) and most of group (2) responded well to conservative management consisting of decompression by nasogastric suction and parenteral feeding but a reoperation was necessary for only two patients in group (2). Half of group (3) was treated by endoscopic dilatation and one third by reoperation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2000

[Successful total gastrectomy of gastric cancer in a congenital factor V deficient patient].

Congenital factor V deficiency is a very rare hereditary coagulation disorder. Total gastrectomy in a patient with factor V deficiency has not been reported in Japan. A 71-year-old woman visited our hospital because of gastric cancer and gallbladder stone. A preoperative screening examination revealed severe anemia, prolonged prothrombin time (35.1 sec.) and activated partial thromboplastin time (109.8 sec.) The value of factor V was 8%. Her parents had a consanguineous marriage. The level of factor V in her two children and a grandchild were lower than the normal limit. We transfused fresh blood and fresh frozen plasma (FFP) preoperatively in order to improve anemia and prothrombin time and activated thromboplastin time. Operating carefully with transfused FFP and fresh blood, we performed total gastrectomy with cholecystectomy successfully. There was no serious tendency to hemorrhage during the operation and the postoperative period. Enough FFP should be transfused during the pre- and postoperative period, paying attention to pulmonary or cardiac failure in elderly patients. Postoperatively, during FFP should be used for 3-10 day with under careful observation of wound bleeding.

Adenocarcinoma↗

PubMed1996

Laparoscopy-assisted radical subtotal gastrectomy for early gastric carcinoma.

In order to evaluate whether it is possible to perform a minimal invasive operation without compromising to the radicality, we analyzed six patients who had been performed laparoscopy-assisted radical subtotal gastrectomy at Yongdong Severance Hospital, Yonsei University College of Medicine between September 1995 and February 1996. All patients were diagnosed as early gastric carcinoma without lymph node metastases preoperatively by upper gastrointestinal barium study (UGI), esophagogastroduodenoscopy (EGD) with biopsy and computed tomography scan (CT-scan). Postoperative pathologic reports revealed that we could obtain the resection margin and regional lymph nodes sufficient enough by laparoscopy-assisted radical subtotal gastrectomy. All patients had a good postoperative course. Flatus was present on the 2nd in a patient and 3rd postoperative day in five patients respectively. Nasogastric tube was removed and oral feeding was started on the day after flatus was present. Minor bile leak was noted in one patient postoperatively and managed conservatively. The postoperative scar was in excellent condition and measured about 2 approximately 3 inches in length. And postoperative courses were uneventful in all except a patient with bile leakage. Further technical experience and development could shorten the operation time. Popular acceptance of this procedure in the management of early gastric carcinoma (EGC) may give great help to the patients.

Adult↗

PubMed2004

Safe major abdominal operations: hepatectomy, gastrectomy and pancreatoduodenectomy in elder patients.

AIM: To evaluate the impact of advanced age on outcome after hepatectomy, gastrectomy and pancreatoduodenectomy. METHODS: Two hundreds and eleven patients undergone hepatectomy, gastrectomy and pancreatoduodenectomy from January 1998 to September 2002 were analyzed retrospectively. Clinicopathologic features and operative outcome of 83 patients aged 65 years or more were compared with that in 128 younger patients aged less than 65 years. RESULTS: The nutritional state, such as pre-operation level of serum albumin and hemoglobin in the older patients was poorer than that in the younger patients. The older patients had higher comorbidities than the younger patients (48.2% vs 15.6%). No significant difference was observed in perioperative mortality, and complication rate between the older and younger patients (2.4% vs 1.6% and 22.9% vs 20.3%, respectively). Multivariate analysis demonstrated that pancreatoduodenectomy, hepatectomy with resection of more than 2 segments and comorbidities were independent predictors of postoperative complication, whereas age was not (P=0.3172). CONCLUSION: It is safe for patients aged 65 years or more to undergo hepatic, pancreatic and gastric resection if great care is taken during perioperative period.

Abdomen↗

PubMed2006

Meta-analysis of short-term outcomes after laparoscopy-assisted distal gastrectomy.

AIM: To elucidate the current status of laparoscopy-assisted distal gastrectomy (LADG) with regard to its short-term outcomes by comparing it with conventional open distal gastrectomy (CODG). METHODS: Original articles published from January 1991 to August 2006 were searched in the MEDLINE, EMBASE, and Cochrane Controlled Trials Register. Clinical appraisal and data extraction were conducted independently by 2 reviewers. A meta-analysis was performed using a random effects model. RESULTS: Outcomes of 1611 procedures from 4 randomized controlled trials and 12 retrospective studies were analyzed. Compared to CODG, LADG was a longer procedure (weighted mean difference [WMD] 54.3; 95% confidence interval [CI] 38.8 to 69.8; P < 0.001), but was associated with a lower associated morbidity (odds ratio [OR] 0.54; 95% CI 0.37 to 0.77; P < 0.001); this was most significant for postoperative ileus (OR 0.27; 95% CI 0.09 to 0.84; P = 0.02). There was no significant difference between the two groups in anastomotic, pulmonary, and wound complications and mortality. Duration from surgery to first passage of flatus was faster (WMD -0.68; 95% CI -0.85 to -0.50; P < 0.001) and the frequency of additional analgesic requirement (WMD -1.36; 95% CI -2.44 to -0.28; P = 0.01), and duration of hospital stay (WMD -5.51; 95% CI -7.61 to -3.42; P < 0.001) were significantly lower after LADG. However, a significantly higher number of lymph nodes were dissected by CODG (WMD -4.35; 95% CI -5.73 to -2.98; P < 0.001). CONCLUSION: LADG for early gastric cancer is associated with a lower morbidity, less pain, faster bowel function recovery, and shorter hospital stay.

Gastrectomy↗