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PubMedDate not supplied

Laparoscopic partial gastrectomy for the treatment of gastropleural fistula.

Gastropleural fistulas (GPF) are uncommon and can occur as a consequence of prior pulmonary surgery, trauma, or malignancy. Conservative management usually fails, requiring gastrectomy and even thoracotomy in these often debilitated patients. We present a patient with GPF confirmed by upper endoscopy and radiographic contrast examination, who underwent a laparoscopic partial gastrectomy and closure of the fistula. To our knowledge, this is the first such report in the English language literature. Laparoscopic treatment of GPF may be associated with less early morbidity and should be considered as the initial procedure of choice.

Aged↗
PubMed2005

[The effects of postoperative continuous epidural analgesia after laparoscopy-assisted distal gastrectomy].

BACKGROUND: This study was conducted to evaluate the effects of continuous epidural analgesia on the postoperative pain and the early recovery after laparoscopy-assisted gastrectomy (LAG). METHODS: A total of 66 patients undergoing elective LAG were investigated for postoperative pain score and other variables retrospectively. RESULTS: Forty-four patients who had received epidural analgesia (E group) showed significantly lower pain scores for 2, 12 and 48 hours after surgery, compared with 22 patients who had received analgesics intramuscularly or transrectally (C group). The patients in the E group needed significantly less supplemental analgesics than those in C group for 2 and 12 hours after the operation. The early recovery and the incidence of postoperative complications were not significantly different between the two groups. CONCLUSIONS: These results show that postoperative continuous epidural analgesia is effective for postoperative pain relief in patients after laparoscopy-assisted gastrectomy.

Analgesia, Epidural↗
PubMed2005

[TS-1 therapy via intestinal catheter used for tube feeding in a patient with gastric cancer after total gastrectomy].

The patient was a 76-year-old man having gastric cancer with peritoneal dissemination. He underwent total gastrectomy for resection of the primary tumor and improvement of the oral intake. He developed ileus and peritonitis after the surgery, which necessitated two additional operations. An intestinal stoma was thus therefore created using a catheter for tube feeding, and tube feeding was initiated after the surgery. Nutrients, as well as TS-1 (taken out of the capsule; 80 mg/day) were administered via the catheter for tube feeding. This therapy was followed by a reduction in tumor marker levels and improvement of the patient's performance status (PS), after which the patient could be discharged. He stayed at home for about 8 months, with a much-improved quality of life during this period. We concluded that the TS-1 therapy via the catheter used for alimentation was effective for the treatment of cancer in this patient. We report our experience with this case, in which tube feeding became necessary after total gastrectomy, but administration of TS-1 via the same catheter used for alimentation improved the patient's PS and made it possible for him to receive chemotherapy at home.

Aged↗
PubMed2005

[Analysis of long-term results of radical gastrectomy combining splenectomy for gastric cancer].

OBJECTIVE: To analyze the influence of radical excision combining splenectomy on prognosis of the patients with gastric cancer. METHODS: Between June 1994 and March 2004, 692 patients were operated on for gastric cancer and registered into gastric cancer database. Radical excision (D2, D3 or D4) combining splenectomy for gastric cancer was performed in 45 cases. 343 cases were selected simultaneously for comparison according to the resembling rules in sex, age, tumor size, location, serosa invasion, Borrmann type and range of lymph node dissection. Clinicopathological factors affecting lymph node metastasis, patterns of lymph node metastasis, 5-year survival rate after radical excision combined with splenectomy for gastric cancer were compared. RESULTS: Lymph node metastasis rate of splenic hilus was 15.6 percent. Among them, upper, middle and lower domain is 11.5 percent, 33.3 percent and zero respectively. It was significantly different between gastric adenocarcinoma in proximal and body of stomach and that in distal stomach, poor differentiation and adenocarcinoma anaplastic and well and moderately differentiation adenocarcinoma, Borrmann III and IV types and Borrmann I and II types, infiltrated depth in T(3) and T(4) and infiltrated depth in T(1) and T(2), clinical stages III and IV and clinical stages I and II. The average and median survival time between radical gastrectomy only and radical gastrectomy combining splenectomy for gastric cancer at stage I and II patients were significantly different, but at stage III and IV patients not significantly different. CONCLUSIONS: Spleen should be reserved for patients with gastric cancer at stage I and II, and radical excision combining splenectomy could only be performed at stage III and IV patients with cancer infiltrating body and tail of the pancreas, or lymph nodes metastasis in the splenic hilus. Indication of radical excision combining splenectomy for gastric cancer must be further study to clarify its efficacy.

Aged↗
PubMed2005

[Postoperative mortality after gastrectomy for gastric cancer: analysis of 1142 cases].

OBJECTIVE: To analyze postoperative morbidity and mortality after gastrectomy for gastric carcinoma and identify main risk factors influencing mortality. METHODS: A total of 1142 patients with gastric cancer received gastrectomy between January 1989 and April 2004. The patients were divided into three groups according to different period, the first group (n=405): from January 1989 to January 1994; the second group (n=377): from February 1994 to January 1999; the third group (n=360): from February 1999 to March 2004. Postoperative morbidity and mortality were compared among three groups, the risk factors influencing postoperative mortality were determined by multiple logistic regression analysis. RESULTS: The total postoperative morbidity and mortality for all patients were 11.2% (128/1142) and 3.6% (41/1142), respectively. The postoperative morbidity was 13.1%, 10.1%, and 10.3% in the first, second, and third group respectively, there was no significant difference in morbidity among the three groups (P > 0.05). The postoperative mortality was 4.7%, 3.4%, and 2.5% respectively (P > 0.05), there was no significant difference in mortality among the three groups (P > 0.05). The most common postoperative complication was anastomotic leakage (24.2%, 31/128). The following clinicopathologic factors were found to be correlated with postoperative mortality: stage IV; palliative excision; multivisceral resection; and preoperative complications (P< 0.05). Multivariate analysis revealed that the extent of lymph node dissection or surgical procedure were not main risk factors influencing mortality. CONCLUSION: Patients with advanced gastric cancer have a high risk of postoperative mortality. Unnecessary lymph node dissection or multivisceral resection should be avoided for patients with stage IV gastric cancer.

Adult↗
PubMed2005

[Anesthetic management for gastrectomy of a patient after coronary artery bypass graft with gastroepiploic artery].

We report anesthetic management of an 80-year-old man who had received coronary artery bypass graft with the gastroepiploic artery 5 years before the present gastrectomy. Preoperative angiography did not show patency of the grafted gastroepiploic artery. He underwent partial distal gastrectomy under general anesthesia with isoflurane in oxygen-enriched air combined with epidural block. The gastroepiploic artery was severed after temporary clamping which did not produce evidence of myocardial ischemia. There was no postoperative cardiovascular event after the surgery.

Adenocarcinoma↗
PubMed2005

Peripheral neuropathy due to thiamine deficiency after inappropriate diet and total gastrectomy.

Peripheral polyneuropathy due to vitamin B1 deficiency was encountered after total gastrectomy for gastric signet cell carcinoma in a patient with a history of breast-conserving surgery for breast cancer. She had greatly reduced her intake of animal foods, believing that would be effective for the prevention of re-occurrence of cancer. Her daily intake of vitamin B1 was less than half of the usual daily requirement. Patients with malignancy tend to adopt unusual diets, and proper advice about food intake is important for such patients, especially those with gastrectomy.

Animals↗
PubMedDate not supplied

[Ratio of lymph node metastasis in gastric carcinoma after D2 gastrectomy].

The classification of lymph node metastasis in patients with gastric carcinoma is controversial. In the past, all systems used for this disease defined N classification by the location of lymph node metastases relatively to the primary tumor. In the 1997, the UICC and AJCC redefined the pathologic nodal status on the basis of the number of involved nodes rather than their location. More recently, the ratio between the number of metastatic and the total examined lymph nodes has been proposed as a new quantitative staging system. Aim of our study was to clarify the outcome of the ratio of the metastatic lymph nodes (RML) in a monoinstitutional series of 164 patient with primary gastric cancer who underwent gastrectomy with D2 lymph node dissection. Our data showed that ratio of metastatic lymph nodes is a simple, convenient, and reproducible staging system with an ability to predict surgical results and it is an independent prognostic factor after D2-gastrectomy.

Gastrectomy↗
PubMed2005

[Total gastrectomy for the surgical treatment of gastric cancer].

We review the work of professor József Imre, who had outstanding ability in surgery and also took part in organizing modern hungarian surgery of oesophagus and stomach. We present the results of operations for malignant gastric tumours performed between 1963 and 1981 in the First Department of Surgery, University Medical School of Szeged. We describe in details the typical data about total gastrectomies and compare the results with what we can achieve in our days. We compare changes in diagnosis, indications, incisions, evaluation of methods of reconstruction, postoperative death, anastomotic leak late survival for total gastrectomies.

Gastrectomy↗
PubMedDate not supplied

[Study of the antireflux action of the Roux-en-Y jejunal loop in reconstruction after gastrectomy and nutritional status in the follow-up].

The Roux-en-Y recostruction after total or subtotal gastrectomy for gastric cancer is frequently performed to prevent esophageal alkaline reflux. Also after total gastrectomy and end-to-side gastrojejunal anastomosis, as usual in former experience, the alkaline reflux can be efficaciously treated by conversion in an esophago-jejunal Roux-en-Y procedure. The main factor preventing reflux is the length of jejunal loop, at least of 35-40 cm. The recostruction with a Roux-en-Y jejunal loop offers the advantage to meet together two primary requirements: the restoration of digestive travel from esophagus to intestine, and the prevention of on alcaline reflux esophagitis, both with relevant simplicity and without a time-consuming surgical technique. Also as a consequence the postoperative morbidity is decreased. The obvious suitable requirement is a sufficient lenght of the jejunal loop for a reservoir of the ingested food and to oppose the antiperistaltic jejunal movements thanks to the effects of the new activated jejunal pace-maker.

Adult↗
PubMedDate not supplied

Laparoscopic sleeve gastrectomy: an alternative for recurrent paraesophageal hernias in obese patients.

BACKGROUND: Recurrent paraesophageal hernias in obese patients are technically challenging and have a high recurrence rate. We sought to develop an alternative to the traditional approaches for this problem. This article describes the use of a sleeve gastrectomy in an obese patient with a large recurrent paraesophageal hernia. CASE REPORT: A morbidly obese 70-year-old woman presented with a 1-year history of chest pain, cough, dysphagia, and dyspnea. She had undergone an open paraesophageal hernia repair 8 years earlier. Diagnostic workup revealed a recurrent large paraesophageal hernia. Laparoscopically, we took down all adhesions, excised the hernia sac, reduced the stomach and distal esophagus into the abdomen, and closed the hiatus. We then resected the greater curvature and fundus of the stomach, leaving the lesser curve in a sleeve configuration. Eighteen months after the operation, the patient's chest pain, cough, dyspnea, and dysphagia were resolved. In addition, she has lost 57 pounds (255 to 198). CONCLUSION: A sleeve gastrectomy is a potentially useful alternative to fundoplication or gastropexy, or both of these, in the treatment of obese patients with complex paraesophageal hernias.

Aged↗
PubMedDate not supplied

Laparoscopy-assisted total gastrectomy for a case of MALT lymphoma: a case report.

A case of laparoscopy-assisted total gastrectomy with regional lymph node dissection for MALT (mucosa-associated lymphoid tissue) lymphoma is reported. The patient was a 45-year-old male with MALT lymphoma. Eradication of Helicobacter pylori as the initial therapy had failed to halt progression of the tumor. Considering certainty of the second therapy, he was transferred to surgical treatment. Total gastrectomy was required and this was performed by the laparoscopy-assisted approach. The postoperative course was satisfactory and the patient has been disease-free for 5 years after the operation. Laparoscopic operation could be a useful option in the second-line treatment for MALT lymphoma after failure to eradicate H. pylori.

Gastrectomy↗
PubMed1991

Gastric adenocarcinoma in the gastric stump after partial gastrectomy.

Carcinomas of the gastric stump are divided into two types. In the main group of patients (n = 18), carcinoma developed after resection for benign ulcer disease, and in the second group (n = 4) after resection for early gastric carcinoma. In the first group, the mean age of the patients was 63, and the male-to-female ratio of 17:1. The mean interval between the primary operation and the diagnosis of cancer was 27 years. Biopsies were positive in 16 out of 18 patients. The resectability rate was 72%, resection being performed with curative intent in 50%. Total gastrectomy was performed in 50% of the cases. There were no postoperative deaths. The 5-year survival rate was 33% for all patients and 50% after tumoral resection. Early detection was achieved by means of an endoscopic survey of the gastric stump. A comparison between gastric stump carcinomas and other gastric carcinomas in our series fails to reveal any major differences. Gastric stump carcinoma is not specific. In the second group, the mean age of the patients was 72.5 and the sex ratio 1:1. The mean interval between the two operations was 5 years. The resectability rate was 100%, and all the patients survived with follow-up ranging from 2 to 10 years. The second lesion could be considered a metachronous cancer, but it may have been present and overlooked at the time of the initial gastrectomy. Differentiating between synchronous and metachronous lesions is quite difficult.

Adenocarcinoma↗
PubMed1991

[An improved antireflux esophageal-intestinal anastomosis in gastrectomy].

An improved method for the formation of a cuff-like end-to-side vertical anastomosis between the esophagus and intestine with antireflux properties was applied in gastrectomy in 142 patients with predominantly stage III gastric carcinoma. The postoperative mortality was 3.5%. Microincompetence of the sutures of the esophago-intestinal anastomosis, which did not result in death, was encountered in 2.1% of patients. Reflux esophagitis occurred in the late-term period in 9.3% of patients, cicatricial strictures of the anastomoses developed in none of the cases. The method suggested for the formation of an esophagointestinal anastomosis is simple, reliable, and may be successfully used in gastrectomy.

Adult↗
PubMedDate not supplied

Interposition of the first jejunal loop for reconstruction after total gastrectomy.

A new technique of reconstruction after total gastrectomy by interposing the first jejunal loop between the esophagus and the duodenum, is described. Vascular and neural integrity of the interposed intestinal segment is "guaranteed", resulting in acceptable muscular activity on intestinal contents and partial digestive function, with limited post-operative complications. The interposed jejunal loop assumes reservoir function and permits almost normal eating habits. Application of this technique to 18 patients undergoing total gastrectomy has resulted in a more than satisfactory post-operative functional and nutritional status over a one to 14 year follow-up period.

Aged↗
PubMed1991

[Long-term follow-up study after pylorus-preserving gastrectomy for gastric ulcer].

The long-term follow-up study of pylorus-preserving gastrectomy (PPG) for benign gastric ulcer was described in terms of postoperative subjective symptoms related to gastrectomy and recurrent ulceration. Of 134 patients who underwent PPG, 5 patients died within one month after operation, 33 patients died in the follow-up period and 22 patients have not been traced. Seventy-four patients were available for a 3-24 year follow-up (mean 16.6 years) Recurrent ulcer developed in 4 patients, 1, 2, 9 and 11 years after surgery at the greater curvature of pre-pyloric region in all cases. Two patients underwent reoperation. These patients revealed higher gastric acid secretion as compared with that of one month after primary operation. But gastrin hypersecretion and G-cell hyperplasia were not recognized in these patients. According to detailed questionnaires, no patient showed the symptoms of dumping syndrome. The results indicate that PPG is preferable for the surgical treatment of gastric ulcer.

Adult↗
PubMed1991

[Choice of radical gastrectomy type II or III (R2, R3) for gastric cancer and its 5-year survival rate].

Of 453 patients with primary gastric cancer, 364 were treated from 1979 to 1988 by radical gastrectomy type R2 or R3. The 1-year survival rate was 96.2% (329/342), 3-year survival rate 83.2% (283/286) and 5-year survival rate 58.5% (86/147). This 5-year survival rate has significantly been improved as compared with that of our previous reports in 1964 (19.6%) and 1972 (39.5%) as well as those from other institutes in China (30-40%). The improvement of treatment result is due to: 1. Adequate selection and application of radical gastrectomy, Type II or III operation and thorough resection of lymph node (N2, N3) metastasis and abdominal wall invasion, 2. Increased incidence of early lesions, and 3. better follow-up. TNM classification, histologic growth pattern, lymph node metastasis, gross type and site of primary cancer all play significant roles in prognosis.

Gastrectomy↗
PubMed1991

[Long-term results of modified supra-pyloric gastrectomy in the treatment of gastric ulcer].

An original technique for supra-pyloric gastrectomy with preservation of sphincter function of the pylorus was performed in a series of 26 patients with benign ulcer of the lesser curvature. The results were evaluated 3-10 years after the operation. Twenty-five patients obtained a satisfactory results (visick grades I or II). The rate of gastric emptying was tested with a meal labelled with TC 99 in 17 patients. Only one patient suffered from gastric stasis. It is concluded that supra-pyloric gastrectomy with preservation of the pylorus has a place in the treatment of benign ulcers of the lesser curvature.

Adult↗