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At least 1,099 records · Page 61Linked to original sources
PubMed1991

Treatment of severe peptic esophageal stricture with Roux-en-Y partial gastrectomy, vagotomy, and endoscopic dilation. A follow-up study.

Eleven patients with dysphagia caused by severe esophageal stricture (length 2 to 10 cm) resulting from reflux esophagitis were treated with fibroendoscopic dilation (Eder-Puestow) and Roux-en-Y partial gastrectomy with vagotomy during 10 years (1979 to 1988). There was no operative mortality, but complications developed in three patients: One patient had a mediastinal abscess demanding thoracotomy as a result of esophageal perforation after dilatation; one had postoperative pneumonia; and one patient had ileus. After a mean follow-up of 4 years (range 1 to 10 years) esophagitis healed in all cases, as judged by endoscopy. Eight patients were asymptomatic, but three had slight transient dysphagia. Postoperatively one to eight dilations (average three to four) were needed to relieve dysphagia in the first postoperative year, but later the stricture healed in every case. Postoperative pH measurement was performed in six latest patients and showed complete absence of reflux in all cases. It is concluded that Roux-en-Y partial gastrectomy with vagotomy and endoscopic dilation is an effective, simple, and safe procedure in the management of severe peptic esophageal (acid or alkaline esophagitis) stricture. However, occasional postoperative dilations at the outpatient clinic are often needed in severe cases in the first postoperative year.

Adult↗
PubMed1991

[Comparison of partial Billroth I, classical Billroth II gastrectomy and resection with Roux-en-Y reconstruction with reference to postoperative quality of life].

53 patients submitted to gastric resection and reconstruction either by means of Roux-en-Y gastrojejunostomy, Billroth I or Billroth II operation were followed for a mean of three years and compared for clinical status using the Visick grading system, dumping grading after the method of Sigstad, and careful clinical questioning regarding post-gastrectomy symptoms. Personal follow up by the same examiner corresponding to a standardized questionnaire and the objective grading revealed that our results for individual operations compared well with the reports of other studies investigating mostly only one type of operation for one criterion. However, the Roux-en-Y reconstruction showed significantly better results when compared to Billroth I and especially Billroth II reconstruction. It is concluded that partial gastrectomy with Roux-en-Y reconstruction is the preferred approach provided that, in the light of the pathology encountered at operation, the procedure is technically feasible and adequate.

Adult↗
PubMedDate not supplied

[Digestive continuity, after total gastrectomy for cancer, via the interposition of a jejunal loop].

The total gastrectomy, as known can expose to some sequences which form on a pathophysiologic and clinic plain syndrome of "AGASTRIC". The most paradigmatic of these disturbances are the weight loss, the pain, the dyspepsia, the anorexia, can be erroneously interpreted as a recurrence of the neoplasm illness. On the base of these disturbances, there are some pathophysiological alterations associated to the resection. The postprandial distension syndrome, the dumping, the diarrhea, the anemia, can be relieved by an appropriated hygienic-diet therapy. The reflux of biliopancreatic secretion into the esophagus, the disturbances related to the duodenal exclusion, the accelerated transit can be loosed or reduced by a correct technic, while the cloridopeptic deficiency is obviously unresolvable. From 1981 till 1988, 43 patients were submitted to a total gastrectomy for adenocarcinoma (29 M, 14 F), having a middle age of 62 years: 30 with a radical intent (Ro), and 13 palliative. Besides 10 of the Ro group were submitted to a enlarged intervention. The digestive continuity was renewed through an interposition of isoperistaltic jejunal loop according Mouchet-Camey in 23 cases, by use of a dysfunctional loop according Roux en-Y in 5, and by esophagus-jejunal T-L anastomosis such omega, according Horloff in 2 cases. There were registered one decrease for A.R.D.S. All the patients were been followed according the follow-up protocol, for monitoring neoplasm evolution of the illness and the eventual metabolic-functional disturbances. In the periodic postoperative control all the patients with Mouchet-Camey reconstruction had no evidenced dumping syndrome, neither cases of malabsorption of the essential nutritive principles, with constant recover of the weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1990

Classification and treatment of anastomotic leakage after extended total gastrectomy in gastric carcinoma.

A new classification of anastomotic fistulas of esophagojejunostomy after total extended gastrectomy for advanced gastric carcinoma is presented. In a group of 230 consecutive patients submitted to total gastrectomy within a 10-year period, there were 20 patients with Type I fistula (8.8%) and 18 cases with Type II (7.8%). Type I or subclinical fistula corresponded to a local leakage around the anastomosis, with no septic complications, which heals with prolongation of enteral feeding up to 20 days after surgery. The mortality rate was 5% in this group. Type II or clinical leakage corresponded to patients with early septic manifestations after surgery, in whom the methylene blue test was positive, that is, immediate appearance of the stain in any drain was observed after oral ingestion, confirmed by radiological studies. The mortality rate in this group was 78%. Resuturing of the fistula was a complete failure. Cervical lateral esophagostomy produced complete healing in two cases. Parenteral and enteral feeding, antibiotics and successful surgical drainage are measured that can provide good results in these cases.

Anastomosis, Surgical↗
PubMed1990

[Gastrectomy at the peak of gastric hemorrhage].

Two patients have been operated at the acme of gastric hemorrhage: one of them had disseminated gastric and the other--combination of giant bleeding ulcer with total acute hemorrhagic-erosive gastritis. Gastrectomy was performed. The former patient recovered, the latter died of hemorrhagic shock 36 hours after the operation. Inferences are drawn on the need of emergency fiber gastroscopy for exact diagnosis of the hemorrhage and early operative intervention in an optimal term after the possibilities for nonoperative treatment have been exhausted. Indications are determined for gastrectomy at the acme of the hemorrhage as a radical operation promising a better outlook during the postoperative period.

Aged↗
PubMed1990

[Total parenteral nutrition in patients undergoing total gastrectomy in cancer of the stomach. A clinical study].

Total gastrectomy is the elective therapy for gastric cancer, but anastomotic dehiscences often improve the results of this surgery, performed in patients with malnutrition due to the neoplasy. The authors present a group of 27 patients treated with total gastrectomy and a routine postoperative TPN; the incidence of dehiscences and postoperative complications is very low. The preoperative evaluation of surgical risk and the choice of pre- and/or postoperative, parenteral and/or enteral nutritional therapy, are discussed.

Aged↗
PubMedDate not supplied

Comparison of nutritional status after total or subtotal gastrectomy.

Forty-four disease-free patients were evaluated a mean of three years after total gastrectomy (TG) or subtotal gastrectomy (SG) for cancer. The investigation encompassed nutritional assessment by standard anthropometric and biochemical indices; evaluation of the nutritional intake based on 24 h recall and of appetite status on a visual analogue scale; and anamnestic analysis of postcibal symptoms and syndromes. Body weight had declined progressively until the 15th postoperative month after both TG and SG. Weight loss, as well as the general nutritional status index (actual body weight/usual body weight +/- actual body weight/desirable body weight + measured arm muscle circumference/reference arm muscle circumference x 33), had dropped more significantly in patients undergoing TG than those having SG (p less than 0.05). The principal body compartment change was observed in the fat content which was severely depleted, whereas the somatic proteins were relatively spared and the visceral proteins and remaining biochemical variables were in the normal range. Protein intake was not significantly different in the two groups, but caloric intake was significantly lower and the number of meals significantly higher after TG (p less than 0.05). These data suggest that malnutrition after TG is relatively mild and that this operation causes only a limited impairment of the nutritional state, and spares most of the nutritional variables of clinical interest in comparison with SG. These findings argue in favor of TG when clinically indicated without excessive concern about postoperative nutrition.

Adult↗
PubMed1990

[A method of creating the esophago-small-intestinal anastomosis in gastrectomy].

In order to prevent postoperative complications related with incompetence of esophago-intestinal anastomoses in gastrectomies, fulfilled for gastric cancer, a modification of the formation of anastomosis of the esophagus with the small intestine is proposed. Operations were performed on 47 patients, in 26 of them combined gastrectomies were fulfilled, in 9 patients the formation of esophageal anastomosis followed sagittal diaphragmotomy. The patients operated upon had no complications associated with incompetence of the esophago-intestinal anastomosis.

Adult↗
PubMed1990

[Digestive reconstruction using mechanical staplers after total gastrectomy].

From 1980 up to nowadays, after total gastrectomy for gastric cancer, the intestinal continuity was assured by oesophago-jejunostomy and oesophago-duodenoplasty using stapling devices. Two patients died for causes not related to the technique, and other two patients developed a stenosis of the oesophago-jejunostomy, which was easily managed by endoscopic dilatation. In one patient a partial dehiscence of the oesophago-jejuno-anastomosis was treated by total parenteral nutrition. The Authors have systematically adopted mechanical sutures after total gastrectomy. However, possible intraoperative accidents and complications should not be underestimated, although most of them may be due to the operator's inexperience or stapler misuse.

Anastomosis, Roux-en-Y↗
PubMed1990

[Esophagojejunal anastomosis after total gastrectomy].

The Authors discuss the technical criteria of digestive reconstruction after total gastrectomy for gastric cancer. Usually they employ stapling devices which are easy and quick to use and give good technical results. Performing a Roux-en-Y with an end-to-side esophagojejunostomy a circular device is preferred and a linear cutter for a side-to-side jejunojejunal anastomosis is used. Alternatively the jejunojejunal anastomosis may be performed with a circular and a linear stapler. Between 1970 and 1989, out of 160 total gastrectomies for cancer, 2 dehiscences were recorded in 103 mechanical anastomosis and none out of 57 manual anastomosis (p: n.s.); stenosis was observed in 2 cases after mechanical esophagojejunostomy and in none after manual anastomosis.

Anastomosis, Roux-en-Y↗
PubMed1990

Neoplastic changes in the stomach after gastrectomy.

Partial gastric resection for benign ulcer disease has been associated with an increased incidence of mucosal dysplasia and invasive adenocarcinoma, particularly 15 to 20 years after resection. These remnant carcinomas are particularly virulent with little hope of resection or cure once symptoms occur. Using a planned protocol of routine endoscopic surveillance with biopsy, the goal was to identify early markers of neoplasia, that is, dysplasia, and a diagnosis of adenocarcinoma of the gastric remnant, while both resection and cure were possible. Between July 1980 and August 1988, yearly flexible gastroscopic examination and random biopsy have been performed on 163 patients at least ten years after gastrectomy for benign ulcer disease. All biopsy results were interpreted for findings of dysplasia and early gastric adenocarcinoma. Results of this ongoing screening program revealed dysplasia of the gastric remnant in nine patients with eventual findings of adenocarcinoma in four of this group. These patients underwent total gastrectomy with findings of limited disease. Five patients with mucosal dysplasia continue to be observed at six month intervals. Three additional gastric carcinomas were found on initial gastroscopic screening, while one patient had adenocarcinoma diagnosed during a third yearly gastroscopic examination. These eight asymptomatic patients with adenocarcinoma in the gastric remnant had a postgastrectomy interval which ranged from 15 to 29 years (mean of 26.5 years). The results of this study support the concept of neoplastic change in the gastric remnant as a function of time from initial gastric resection. Findings of dysplasia on random biopsy indicate a greater likelihood of development of carcinoma of the gastric remnant and identify a subset of patients requiring aggressive endoscopic surveillance.

Adenocarcinoma↗
PubMed1990

Intraperitoneal administration of the biological response modifier OK-432 and peritoneal recurrence following gastrectomy.

In patients with gastric cancer invading the serosa, there is often peritoneal dissemination. In an attempt to control such peritoneal recurrences, OK-432, a compound composed of penicillin G-treated, attenuated Streptococcus pyogens of human origin, was administered intraperitoneally at the time of gastrectomy. The non-specific antitumor activity of the peritoneal macrophages was investigated for its cytostatic activity against the cultured human lung cancer cell line, QG-90. OK-432 given intraperitoneally significantly increased the number of the peritoneal macrophages (p less than 0.05), and also enhanced the cytostatic activity (p less than 0.01). On the basis of these findings, OK-432 IP after gastrectomy was given to 13 of 68 patients with gastric cancer invading the serosa and who underwent curative resection. The five-year survival rate of patients given the drug was 63.5%, while the rate was 52.9% in those not given the drug. OK-432 IP seemed to be effective when lymph node involvement was nil or limited to around the area of the stomach. The peritoneal recurrence rate was, however, not affected by OK-432 IP. Elevation of body temperature and some dehydration were the only observed side effects of OK-432. In attempts to control peritoneal recurrences in patients with gastric cancer invading the serosa, randomized controlled trials on OK-432 IP are now being designed.

Adenocarcinoma↗
PubMed1990

[Treatment of alkaline gastritis and recurrent ulcer following Roux-en-Y gastrectomy and construction of a Rumpf antireflux valve].

Two-third gastrectomy or supplementary gastrectomy was performed on 13 patients, between July 2, 1986 and September 30, 1988. Continuity of the gastro-intestinal tract was restored by end-to-side gastrojejunostomy according to Roux-en-Y. An antireflux valve according to Rumpf was inserted 15 cm below the gastroenteroanastomosis, and end-to-side jejunostomy was performed about six centimetres below the valve. This surgical method was applied to six patients for treatment for alkaline gastritis. The same method was used on another seven patients to prevent development of alkaline gastritis. All the 13 patients were males aged between 42 and 77 years. There were no postoperative problems in any of them. Follow-up checks were made 12 to 36 months after surgery and confirmed the effectiveness of this surgical approach for both healing and prevention of alkaline gastritis.

Adult↗
PubMed1990

Malignant Zollinger-Ellison syndrome. Stabilization of liver metastasis after gastrectomy with resection of primary tumor.

A case of malignant gastrinoma of the jejunum and jejunal mesentery, with findings of metastasis in the liver was studied. Tumor resection and remnant gastrectomy, as well as liver biopsy, were performed. Of all the tumors removed, the metastatic tumor had the lowest gastrin content, which was 1.5 times that found in normal human antral mucosa. The gastrin distribution was of four peaks and one peak for the main tumor, versus two peaks for the metastatic tumor in which G17 was the main component. Seven years after the operation, computed tomography (CT) scan indicated there was stabilization of the liver metastasis, and now, ten years after the total gastrectomy, the patient is well and working full-time. Such an analysis can be of value in determining the prognosis in cases of malignant gastrinoma with liver metastasis.

Adult↗
PubMed1990

[The effect of glucose loading on changes in ketone and glucose metabolism during gastrectomy].

Plasma glucose, insulin, glucagon, free fatty acid, ketone body, lactate and pyruvate were measured in 14 patients undergoing gastrectomy under general anesthesia with nitrous oxide and oxygen. Lactated ringer solution with glucose load (10 g.hr-1) was administered in seven patients [glucose loading group: Glucose (+)] and the other seven patients received only lactated ringer solution [glucose free group: Glucose (-)]. Blood glucose increased significantly in both groups, but a significant difference appeared between Glucose (+) and Glucose (-). Plasma insulin activity and IRI/BS ratio increased in Glucose (+) and a significant difference was found between the two groups. No remarkable change in plasma glucagon level was found in both groups. Free fatty acid and ketone bodies (acetoacetate, beta-hydroxybutyrate) decreased significantly in Glucose (+), but they increased significantly in Glucose (-) and significant differences were found between the two groups. The rate of changes of beta-hydroxybutyrate was consistently higher than that of acetoacetate. Lactate and pyruvate increased significantly in both groups. These results suggest that continuous glucose loading may facilitate insulin release from the pancreas and suppress the hyperketonemia and hyperlipidemia during partial gastrectomy.

Blood Glucose↗
PubMed1990

Adjuvant 5-FU and MeCCNU improves survival following curative gastrectomy for adenocarcinoma.

During the 13-year period ending December 31, 1984, 51 patients treated by curative gastrectomy for gastric adenocarcinoma invasive beyond the submucosa were eligible to enter adjuvant chemotherapy trials. Twenty-one of 22 patients in the first treatment group (FMe) received 5-fluorouracil and a nitrosourea. The second group of eight patients received the same drugs plus Adriamycin (FAMe). Twenty-one patients were observed as surgical controls. Each adjuvant treatment group was subdivided into groups of patients with zero to four or five or more lymph node metastases for survival analysis. Fifteen patients were alive without evidence of disease at five years. Analysis of variance of survival times showed that lymph node status (P = 0.0001) and adjuvant chemotherapy (P = 0.01) were statistically significant prognostic variables. The FMe group had the best survival. A Fisher's exact test showed that the FMe group had a greater proportion of five-year survivors (P = 0.0217) than the no treatment arm. Patients with only zero to four positive lymph nodes in the FMe group had a statistically greater number of five-year survivors than patients in the no treatment arm (P = 0.0155). In this series, postoperative 5-fluorouracil and MeCCNU significantly improved the survival times of patients after curative gastrectomy for adenocarcinoma as compared with surgical controls.

Adenocarcinoma↗
PubMed1990

Nutritional consequences of total gastrectomy: the relationship between mode of reconstruction, postprandial symptoms, and body composition.

Body composition, postprandial symptoms, and social performance were assessed in 41 patients who were free of tumors 16 to 63 months (median, 41 months) after total gastrectomy with Roux-en-Y esophagojejunostomy (n = 15) or jejunal interposition (n = 26). There were no significant differences with respect to age, sex, initial tumor stage, interval since operation, and premorbid weight/height2 (body mass index). The lowest postoperative body mass index (BMI) was 72% +/- 3% of the preillness BMI in patients with Roux-en-Y reconstruction and 79% +/- 2% in patients with jejunal interposition (p less than 0.05). At the time of the study the relative BMI was 88% +/- 2% of the preillness BMI in patients with jejunal interposition but only 81% +/- 3% in patients with the Roux-en-Y reconstruction (p less than 0.01). Muscle mass and lean body mass estimated from anthropometric and bioelectric impedance measurements were correlated with sex (p = 0.0001) and with the mode of reconstruction (p = 0.02) independently, which was confirmed by multiple linear regression. The postprandial symptoms were not significantly associated with changes in body composition except for an inverse relationship between Sigstad's dumping score and the extracellular mass/body cell mass ratio (r = 0.553; p = 0.0002). Of the patients under 60 years of age, 10 of 15 patients with jejunal interposition and two of eight patients with Roux-en-Y reconstruction were back at work (p = 0.057). The persons who had resumed their work had a significantly higher relative BMI (90% +/- 2% vs 82% +/- 3%), lean body mass (53 +/- 3 kg vs 46 +/- 3 kg), and muscle mass (25 +/- 2 kg vs 21 +/- 1 kg) than persons in early retirement. We concluded that preserving the duodenal transit should be a main objective of gastric replacement after total gastrectomy.

Anastomosis, Roux-en-Y↗
PubMedDate not supplied

Total gastrectomy in the elderly patient.

Postoperative morbidity and mortality were studied in 72 patients who consecutively underwent total gastrectomy for primary gastric malignancy. Patients aged greater than or equal to 70 years (n = 32) were compared with younger patients (n = 40). Two patients in both groups died postoperatively, making the surgical mortality 6.3% and 5%, respectively. Major surgical complications arose postoperatively in 12 cases. Conservative measures (balloon dilation of anastomotic stricture, protracted drainage, and puncture and drainage of intraabdominal abscess) sufficed in five cases, while reoperation was required in seven. One of these seven patients died. The remaining three deaths were due to myocardial infarction, cerebral vascular insult and exudative pericarditis, respectively. The median postoperative hospital stay was 14 days in the younger and 15 days in the older patient group. Approximately half of the patients in both groups were alive 2 years postoperatively. Total gastrectomy is a meaningful and reasonably safe operation for primary gastric malignancy also in elderly patients.

Adult↗