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At least 19 recordsLinked to original sources
PubMed1978

Treatment of severe side effects after vagotomy and gastroenterostomy by closure of gastroenterostomy without pyloroplasty.

We describe nine patients who had severe, persistent abdominal pain, vomiting, dumping, or diarrhoea several years after truncal vagotomy and gastroenterostomy had been performed for duodenal ulceration. Each patient was judged to have a bad clinical result (Visick grade 4). There was no evidence of recurrent ulceration in any of the patients, and in each the patency of the pyloric canal was confirmed radiologically or endoscopically. Each patient was treated by simply dismantling the gastroenterostomy without addition for a pyloroplasty. In one patient the surgeon suspected that a vagal trunk might have been left intact, and a revagotomy was performed by the "highly selective" technique. Postoperatively, none of the patients developed gastric retention. Symptomatic improvement occurred in eight patients, and four of them achieved perfect results (Visick grade 1). Side effects are common after vagotomy and gastroenterostomy, and are largely attributable to the presence of the gastroenterostomy stoma. Our results show that the symptoms may be alleviated by closing the gastroenterostomy, without precipitating gastric retention.

Adult↗
PubMed1995

Role of prophylactic gastroenterostomy for unresectable pancreatic carcinoma.

Methods of palliation and the use of prophylactic gastroenterostomy in the treatment of unresectable pancreatic carcinoma remain controversial. Gastroenterostomy has been linked with various complications. We conducted a 10-year (1982-1992) retrospective review of patients who had unresectable pancreatic carcinoma and underwent biliary decompression without prophylactic gastroenterostomy. 50 patients were studied. Only four patients (8%) developed duodenal obstruction and required reoperation for therapeutic gastroenterostomy. The mean time to obstruction was 15.75 months, whereas the mean overall survival was 12.99 months. The mean survival of patients who underwent therapeutic gastroenterostomy was 32.25 months, with an average palliation of 16.5 months after the second operation. We conclude that pancreatic carcinoma has a rapid natural progression, and most patients do not survive long enough to obstruct. The ones who do obstruct are unique in that they survive for a long period of time. We recommend that routine prophylactic gastroenterostomy is unnecessary, and selective use of gastroenterostomy should be exercised in case of present or impending duodenal obstruction.

Aged↗
PubMedDate not supplied

Is there a place for gastroenterostomy in patients with advanced cancer of the head of the pancreas?

There remains doubt about the need for gastroenterostomy in patients with advanced cancer of the pancreatic head, performed either prophylactically or when passage of food becomes impossible. The records of 142 patients admitted for advanced pancreatic cancer to the Erasmus University Hospital over a period of 11 years were reviewed. We concentrated especially on the pre- and postoperative intake of food in cases involving gastroenterostomy and the morbidity and mortality associated with abdominal surgery in these patients. Of 129 patients without symptoms of gastric outlet obstruction at the time of diagnosis, 31 underwent prophylactic gastroenterostomy. The procedure did not prevent gastric outlet obstruction in 4 patients. Of the remaining 98 patients, 15 developed gastric outlet obstruction. Cox proportional hazards analysis showed no significant difference in the interval to the occurrence of a symptomatic obstruction between these two groups, taking into account other covariables. Postoperative complications and mortality regarding a gastroenterostomy were high, ranging from 9% to 41% and 11% to 33%, respectively. Our results do not indicate that prophylactic gastroenterostomy may significantly prevent future gastric outlet obstruction; therefore, as it also increases morbidity, it should not be performed. A gastroenterostomy to relieve symptoms should be considered carefully, as the success rate is low and is accompanied by a considerable incidence of morbidity and mortality.

Adult↗
PubMed1991

A comparative study of gastric histopathology after partial gastrectomy between the gastroenterostomy area and gastric body.

One hundred and thirty partially gastrectomized subjects, who had been operated on for benign peptic ulcers, were studied to assess the histologic changes in the remaining gastric mucosa and its implications for gastric carcinogenesis. Endoscopic examination and multiple mucosal biopsies from the gastroenterostomy area and gastric body were compared histopathologically. Gastric carcinoma was found in two instances among these 130 patients, making a prevalence rate of 1.5% for carcinoma in the residual stomach. Chronic atrophic gastritis and pseudopyloric metaplasia were found to have developed more often in the gastroenterostomy mucosa than in the gastric body mucosa (p less than 0.001). The mean value of the gastritis score for gastroenterostomy mucosa (2.7 +/- 1.3) was statistically higher than that for the gastric body (2.1 +/- 1.0; p less than 0.001). The degree and types of histologic alteration in the gastric mucosa were also affected by the type of operation and by the postoperative duration. The mean value of the gastritis score and the frequency of pseudopyloric metaplasia, whether in the gastroenterostomy area and/or at the gastric body, were higher in Billroth II resections than in Billroth I resections. The gastritis score and the frequency of pseudopyloric metaplasia increased as the postoperative period increased. However, in the same postoperative period, the mean values of the gastritis score and the frequency of pseudopyloric metaplasia were higher in the gastroenterostomy mucosa than in the gastric body. Gastric dysplasia was more common in the gastroenterostomy area than in the gastric body. Patients who had received a Billroth II resection and those with a longer postoperative period had a higher frequency of gastric dysplasia.

Female↗
PubMed1989

[Palliative biliodigestive anastomosis in non-resectable cancer of the head of the pancreas--with or without preventive gastroenterostomy?].

In 226 patients with malignant obstructive jaundice over a 10-year period (1975-1984) 92 presented with an unresectable carcinoma of the head of the pancreas and were treated with a palliative bilioenteric diversion: in 52 cases alone, in 20 cases with a therapeutic gastroenterostomy because of early duodenal obstruction, and in 20 cases with a simultaneous prophylactic gastroenterostomy. The latter did not increase perioperative morbidity (25% vs. 50% in bilioenteric diversion alone), mortality (5% vs. 19%) nor length of hospital stay (19.9 vs. 20.6 days). Later on patients with a prophylactic gastroenterostomy showed a decreased incidence of chronic vomiting (15% vs. 42%). No secondary gastroenterostomy was performed in this group, vs. 14% (6 patients) in cases with bilioenteric diversion alone (mortality 33%). We recommend the simultaneous prophylactic gastroenterostomy which does not increase morbidity, mortality and length of hospital stay and helps avoiding a risky secondary gastroenterostomy.

Aged↗
PubMed1989

Role of gastroenterostomy in the palliative surgical treatment of pancreatic cancer.

The records of 72 consecutive patients with unresectable pancreatic cancer treated between 1974 and 1986 were evaluated to determine whether gastroenterostomy should be performed on a routine basis at initial intervention or on a therapeutic basis. Fourteen patients underwent an explorative laparotomy, 41 patients underwent biliary bypass, and 17 patients required biliary bypass and therapeutic gastroenterostomy at initial laparotomy. The mortality and morbidity rates in this last group were 18 and 59%, respectively. The most common complication was delayed gastric emptying (29%). Of the 37% of patients who required gastroenterostomy after initial biliary bypass, the mortality rate was 50% and delayed gastric emptying occurred in 57%. The mean survival after biliary bypass was 9.4 months while survival after therapeutic gastroenterostomy averaged 4.2 months. These findings suggest that gastroenterostomy should be performed on a prophylactic basis at initial intervention, unless a limited survival is expected.

Adolescent↗
PubMed1994

Roux-en-Y gastroenterostomy severely disturbs emptying of the gallbladder.

BACKGROUND: It is documented that truncal vagotomy and Billroth II gastroenterostomy disturbs the emptying of the gallbladder. The aim of the present prospective study was to assess the emptying of the gallbladder after Roux-en-Y gastroenterostomy. STUDY DESIGN: There were 34 patients, who had undergone either truncal vagotomy with pyloroplasty (TVP, 14 instances) or Billroth II gastrectomy (20 instances), and were subsequently subjected to Roux-en-Y gastroenterostomy. The emptying of the gallbladder was assessed before and after the Roux-en-Y procedure, by milk-technetium-99m labeled hepatoiminodiacetic acid (milk-99mTc-HIDA) scintigraphy. Milk-99mTc-HIDA scintigraphy was also performed on twenty-eight healthy subjects, who served as the control group. RESULTS: After excluding the subjects having spontaneous gallbladder evacuation before milk ingestion, there remained 26 subjects in the control group, 12 patients with TVP, and 19 with Billroth II gastrectomy. Truncal vagotomy with pyloroplasty was associated with delayed onset (p < 0.001) and decreased rate (p < 0.01) of emptying of the gallbladder compared with the control group. Truncal vagotomy with pyloroplasty also changed the normal pattern of emptying in two patients (sequential emptying and refilling events). Billroth II gastrectomy was associated with decreased extent and abnormal pattern of emptying compared with subjects in the control group (p < 0.0001) and patients having TVP. Roux-en-Y gastroenterostomy, performed upon patients with TVP, significantly increased lag phase duration (p < 0.001), decreased ejection fraction (p < 0.01), and changed the pattern of emptying of the gallbladder (p < 0.01). Roux-en-Y procedure performed upon patients with Billroth II gastrectomy significantly increased lag phase duration (p < 0.0001). CONCLUSIONS: Roux-en-Y gastroenterostomy severely disturbs all parameters of the emptying of the gallbladder.

Adult↗
PubMed1984

Palliative gastroenterostomy for pancreatic cancer.

The records of 125 consecutive patients with unresectable pancreatic cancer treated between 1958 and 1979 were evaluated to determine the benefit or morbidity of gastroenterostomy performed on a routine basis. One hundred three patients had no evidence of gastric outlet obstruction from tumor extension as determined at the time of initial operation. Fifty-seven of these patients underwent biliary diversion as their only operative procedure. The morbidity and mortality in this group was 31 and 14 percent, respectively. Six of these 57 patients required decompressing gastroenterostomy at a later date to relieve gastric outlet obstruction. Forty-six patients underwent both biliary and prophylactic gastric outlet diversion with a 15 percent mortality rate and a 46 percent incidence of morbidity. The most common complication in this group was delayed gastric emptying (14 percent). These findings, and the high incidence of delayed gastric emptying after gastroenterostomy and the relatively infrequent occurrence of gastric outlet obstruction (11 percent) after initial biliary diversion, suggest that gastroenterostomy should be performed on a selective basis only.

Aged↗
PubMed1995

Laparoscopic gastroenterostomy for duodenal obstruction.

BACKGROUND: It is not yet clear where laparoscopic procedures will fit into the armamentarium of the surgeon. Over the past decade, there has been a clear trend toward minimally invasive procedures for palliation of inoperable cancer. Traditionally, when duodenal obstruction occurs secondary to a disease process, gastric bypass through laparotomy is required. PATIENTS AND METHODS: Between November 13, 1992 and September 13, 1994, 10 patients underwent laparoscopic gastroenterostomy for duodenal obstruction. In 9 patients, the procedure was carried out for malignant obstruction; in 1 patient, duodenal obstruction was secondary to chronic scarring from benign peptic ulcer disease. Eight of these patients already had biliary decompression through radiologic or endoscopic means. One patient underwent laparoscopic cholecystenterostomy for biliary obstruction in addition to the laparoscopic gastroenterostomy. RESULTS: Laparoscopic gastroenterostomy was successfully completed in 8 of the 10 patients. In 2, conversion to open surgery was necessary. There was no mortality related to this operative approach. CONCLUSIONS: Laparoscopic gastroenterostomy is a safe procedure for treatment of duodenal obstruction. Good palliation can be expected in patients with obstruction of the duodenum secondary to advanced malignancies.

Aged↗
PubMed1981

Role of gastroenterostomy in patients with unresectable carcinoma of the pancreas.

A group of 107 patients with unresectable carcinoma of the pancreas who underwent simultaneous biliary bypass and gastroenterostomy were compared with a group of 107 matched patients who underwent biliary bypass only. Hospital mortality was identical. A longer hospital stay was evident after concomitant gastroenterostomy and was related to problems with delayed gastric emptying. However, the patients with this complication had preoperative signs or symptoms suggestive of partial or impending duodenal obstruction. Notably, eight of 53 patients with adequate follow-up data after biliary bypass alone required gastroenterostomy within nine months because of duodenal obstruction. Results of our experience suggest that patients with a favorable prognosis who undergo palliative biliary bypass for carcinoma of the pancreas should also undergo a gastroenterostomy.

Adenocarcinoma↗
PubMed2004

Stenosis of the gastroenterostomy after laparoscopic gastric bypass.

BACKGROUND: Stenosis of the gastroenterostomy after laparoscopic Roux-en-Y gastric bypass (LRYGBP) is a serious problem that occurs after stapled (linear or circular) and hand-sewn anastomoses. METHODS: Data was prospectively entered into a database to track complications of bariatric surgery. Between Feb 27, 1999 and June 13, 2000, 1000 patients underwent LRYGBP. All patients met NIH criteria for bariatric surgery.The gastroenterostomy was constructed with a linear stapler inserted to 20 mm (15 mm cut). The stapler defect was closed with a polyester running suture to construct a 12-mm diameter anastomosis. The anastomosis was banded with fascia lata to prevent late enlargement. All patients with suspected stenosis were endoscoped. RESULTS: 32 patients (3.2%) developed stenosis (<10 mm diameter orifice) at the gastroenterostomy. There were 27 females. Average age was 44.8. Average BMI was 45.0. Average stenotic orifice was 5.7 mm in diameter. Stenoses occurred in 18 of 32 patients (56.3%) by 3 months, 26 (81.3%) by 6 months, and 31 (96.9%) by 1 year. 30 of the 32 patients underwent endoscopic dilation as initial therapy. 17 of the 32 underwent multiple dilations. Dilation caused 4 perforations, resulting in 2 emergency operations. Perforation occurred at the first attempt at dilation in 3 of 4 patients. Stenoses could not be successfully dilated in 8 patients, and all 8 underwent surgical revision. There were no deaths in these 32 patients, but there were 68 dilations and 10 re-operations. CONCLUSION: Stenosis of the gastroenterostomy after LRYGBP is an infrequent but serious problem, which results in considerable morbidity.

Adult↗
PubMed1989

Delayed return of gastric emptying after gastroenterostomy.

A retrospective study of patients having gastroenterostomies was undertaken to identify predictive factors for the development of postoperative delayed return of gastric emptying (DRGE). A total of 322 consecutive patients underwent 324 gastroenterostomies; 35 experienced delayed return of gastric emptying. Regression analysis demonstrated preoperative obstruction to be the most significant factor (P less than 0.001). Vagotomy was not an independent variable. Age, sex, size of stoma, anastomotic technique, albumin and experience of the operator were not significant factors. Gastroenterostomy in the presence of 'gastric atony' was likely to produce DRGE. In all, 86 per cent of cases resolved spontaneously. Only one case of DRGE was found to have a mechanical cause. Most patients were supported by parenteral nutrition but, with a knowledge of the identified risk factors, more thought could be given to establishing a route for jejunal feeding at the time of surgery.

Adolescent↗
PubMed1977

Is reduced release of gastrin the mechanism of ulcer healing after gastroenterostomy?

Until recently in this unit gastroenterostomy was the operation of choice for patients with duodenal ulcer whose maximal acid output (MAO) is less than 30 mmol/hr. Ulceration (jejunal) has recurred in only 2.1%. Unlike partial gastrectomy, which has a peak incidence of ulcer recurrence in the first two years, the incidence of ulcer recurrence remains constant throughout the years after gastroenterostomy. In looking for the explanation of this low recurrence rate we have studied the effect of the operation upon serum gastrin responses to standardized test meals 3 weeks and 26 weeks after operation in 9 patients. Nine normal subjects acted as controls. Six months after operation the responses were significantly lowered, a fall in the serum levels of gastrin at 30, 45, 60 and 90 min after means suggesting that gastroenterostomy reduces both the gastric and intestinal phases of acid secretion. The mean integrated gastrin response (IGR) throughout the postprandial 90 min is also significantly lower 6 months after surgery. The overall mean reduction was 31.1%.

Adult↗
PubMed1985

Impact of radiotherapy on palliative gastroenterostomy in pancreatic cancer.

The previously unaddressed impact of radiotherapy and vagotomy on palliative gastroenterostomy (GE) in patients with unresectable pancreatic cancer was studied. Sixty-eight patients were retrospectively evaluated. A higher overall incidence of complications was found in the group (N = 44) undergoing irradiation as well as gastroenterostomy compared to a group undergoing gastroenterostomy alone. The increased complications were due to 16 episodes of bleeding among the irradiated patients. Rates of obstructive complications were similar for both groups (20%). Rates of bleeding were highest among patients undergoing prophylactic GE and irradiation compared to those receiving GE alone. Vagotomy in 12 patients who were irradiated did not appear to protect against bleeding. We found the irradiated prophylactic GE to provide poor palliation in patients with unresectable pancreatic cancer and recommend it not be performed if radiotherapy is to be used for attempt in local control of unresectable pancreatic cancer.

Adult↗
PubMed1979

Stomal polypoid hypertrophic gastritis: a polypoid gastric lesion at gastroenterostomy site.

Four cases of stomal polyps (the so-called gastritis cystica polyposa--GCP) at the gastroenterostomy site were studied with detailed description of their macroscopic and histologic features. Thirty-eight cases with reresection of the stomach including the site of previous gastroenterostomy were used for a comparative study. In 25 (66%) of the 38 cases localized mucosal hypertrophy of varying degrees was recognized near the site of anastomosis, the morphology corresponding well, though of the smaller scale, to that of the GCP both macroscopically and histologically. Macroscopic and histologic continuity was traced between the minimal protrusion of the stomal gastric mucosa and the stomal polyps. It is suggested that the GCP is an extreme occasion of stomal gastritis characterized by atrophy and pseudopyloric gland metaplasia of the fundic glands often with their submucosal invasion and hyperplasia of the surface and foveolar epithelia, these being probably caused by reflux of duodenal contents. It must be borne in mind that such lesions do exist at the site of gastrojejunostomy to be strictly differentiated from malignancies at the gastric stump.

Adult↗
PubMed1977

[Bacterial flora and nitrite production in the stomach after gastroenterostomy. Experimental aspects of the pathogenesis of carcinoma in the operated stomach (author's transl)].

A gastroenterostomy without enteroanastomosis leads to a change in the bacterial flora of the stomach, where-by in particular the proportion of nitrite-decomposing bacteria, is enhanced. This results in an increase of nitrite concentration in the gastric fluid, which may possibly be accompanied by an augmented production of carcinogenic nitrosoamine. This latter aspect is considered with respect to the origin of carcinoma in the operated stomach. Since the reported changes will be largely prevented by a Roux-Y-gastroenterostomy, this should be taken into consideration for reconstruction of the alimentary tract after gastric surgery.

Animals↗