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At least 19 recordsLinked to original sources
PubMed1976

Postgastrectomy syndromes.

Postgastrectomy syndromes requiring further operation are fortunately uncommon, as the symptoms are disabling and the results of corrective surgery are, at times, disappointing. Our sixty-six patients underwent a total of seventy-six procedures with forty-one successful results and thirty-five failures. Among the secessful group, only fourteen results were graded as excellent. (Table V.) Our experience, like that of others, demonstrates the necessity of accurate evaluation of the patient and of accurate syndrome classification. This not only allows the appropriate operation to be chosen but also helps to indicate those in whom operation should be avoided. Where more than one surgically remediable syndrome exists, simultaneous correction should be undertaken. Treatment of the mechanical problems of obstructed afferent loop by jejunojejunostomy and of stomal obstruction by complete stomal reconstruction provides satisfactory results. Roux-en-Y anastomosis is effective in patients with alkaline gastritis, but we caution against the use of this procedure in patients with vague symptoms and minimal endoscopic changes. Antiperistaltic jejunal reversal is the procedure of choice in managing severe postvagotomy diarrhea. Although most patients with dumping can be managed conservatively, a small number with severe symptoms and nutritional problems cannot and require further operation. Our experience with conversion from Billroth II to Billroth I and with isoperistaltic interposition, although minimal, has been reasonably satisfactory. Four groups of patients remain with symptoms of chronic vomiting, late postvagotomy atonic stomach, dumping "plus," and miscellaneous symptoms. These patients have complaints that are difficult to define and usually have poor results with further operations. We believe that surgery should be avoided in these patients and that conservative measures be continued.

Adult↗
PubMed1992

[The Roux loop syndrome: a postgastrectomy syndrome. Description of 2 clinical cases].

The Roux-En-Y operation has been used to control enterogastric reflux occurring after previous distal gastric resection and it has been used extensively in the treatment of alkaline reflux. Recently a postgastrectomy syndrome characterized by chronic abdominal pain, persistent nausea and vomiting that is exacerbated by eating and that develops after the Roux-En-Y operation has been described. It has therefore been postulated that the Roux-En-Y limb acts as a functional obstruction and causes the symptoms.

Anastomosis, Roux-en-Y↗
PubMed2000

Jejunal interposition to prevent postgastrectomy syndromes.

BACKGROUND: Postgastrectomy syndromes include reflux gastritis and oesophagitis, dumping syndrome, intractable diarrhoea and afferent loop syndrome. To prevent such syndromes, since January 1994 jejunal interposition has been used following distal gastrectomy. The aim of this study was to evaluate the benefit of this procedure. METHODS: A consecutive series of 42 patients who underwent distal gastrectomy for gastric cancer was studied. Twenty-two patients had a Billroth I procedure before January 1994, and 20 patients had isoperistaltic jejunal interposition using a 10-12-cm segment after January 1994. RESULTS: The mean operating time was 260 min for Billroth I and 352 min for jejunal interposition. No serious postoperative complications arose. Reflux gastritis occurred in 19 patients after Billroth I but in none after jejunal interposition. Five patients in the Billroth I group had complaints consistent with dumping syndrome, compared with none after jejunal interposition. The barium gastric emptying time was significantly shorter after Billroth I (mean(s.d.) 269(225)s) than after jejunal interposition (736(479) s) (P < 0.01). CONCLUSION: Jejunal interposition prevented reflux gastritis and inhibited rapid gastric emptying. Postgastrectomy syndromes were effectively prevented by this reconstruction procedure.

Adult↗
PubMed1992

Postgastrectomy syndromes.

Anatomic and physiological changes introduced by gastric surgery result in postgastrectomy syndromes in approximately 20% of patients. Most of these disorders are caused by operation-induced abnormalities in the motor functions of the stomach, including disturbances in the gastric reservoir function, the mechanical-digestive function, and the transporting function. Division of the vagal innervation to the stomach and ablation or bypass of the pylorus are the most significant factors contributing to postgastrectomy syndromes. Either rapid or slow emptying may result, depending on the relative importance of lack of a compliant gastric reservoir, loss of an effective contractile force, and loss of controlling factors that slow or speed gastric emptying and result in duodenal-gastric reflux. Clearly defining which syndrome is present in a given patient is critical to developing a rational treatment plan. In syndromes with slow gastric emptying, bilious vomiting, or alkaline reflux gastritis, the use of endoscopy is essential to rule out mechanical causes of the syndrome. Contrast radiography and scintigraphic gastric emptying studies are useful to document rapid or delayed gastric emptying. Postgastrectomy syndromes often abate with time. Conservative measures, including medical, dietary, and behavioral therapy, should be given at least a 1-year trial. If these nonoperative measures fail, surgical therapy is recommended. The Roux-en-Y gastrojejunostomy is useful for patients with dumping, because it slows gastric emptying and the transit of chyme through the Roux limb. The same operation helps patients with alkaline reflux gastritis, because it diverts pancreaticobiliary secretions away from the gastric remnant. Near-total gastrectomy, which reduces the size of a flaccid gastric reservoir, can be used to treat delayed gastric emptying. This operation should be combined with the Roux procedure to prevent postoperative reflux gastritis and esophagitis. Newer techniques, such as gastrointestinal pacing and the uncut Roux operation, may improve the treatment of the postgastrectomy syndromes in the future.

Afferent Loop Syndrome↗
PubMed1967

Clinical experiences with jejunal interposition for postgastrectomy syndrome.

Remedial operation for intractable postgastrectomy syndrome utilizing an isoperistaltic jejunal segment interposed between the gastric remnant and duodenum has been highly successful in the hands of European surgeons. This secondary operation is rarely performed in this country. The author reports his experience with three patients. The initial results were uniformly excellent. In time, some symptoms recurred in two patients.

Adult↗
PubMed1991

Surgical options in postgastrectomy syndromes.

The various operations performed for the treatment of peptic ulcer disease can lead to a variety of iatrogenic disorders collectively referred to as the "postgastrectomy syndromes." Although the etiology of most of these disorders remains unclear, loss of vagal innervation and bypass, ablation, or destruction of the pylorus clearly are involved in the pathogenesis of most, if not all, of these disorders. Unfortunately, there often is also a poorly understood psychological element involved in the pathogenesis. Of all ulcer operations, proximal gastric vagotomy results in the fewest physiologic abnormalities and the mildest postoperative symptoms. The continued popularity of this operation should effect a marked reduction in the incidence of disabling postgastrectomy syndromes. Fortunately, symptoms severe enough to necessitate remedial operation are uncommon, and conservative medical management is always indicated and usually suffices. When disabling symptoms are refractory, a thorough evaluation of the patient and an accurate classification of the syndrome are essential to guarantee a satisfactory result from surgical intervention. Although numerous surgical procedures have been developed to deal with the different syndromes, with varied results, the Roux-en-Y procedure has emerged as the operation of choice for most, if not all, postgastrectomy syndromes. However, the Roux-en-Y procedure has not been universally successful, and this operation can itself lead to the recently recognized postgastrectomy state of Roux-en-Y stasis syndrome. Prevention therefore remains the best form of therapy, and remedial operation should not be undertaken until adequate time has elapsed since the original operation and all forms of conservative treatment have failed.

Diarrhea↗
PubMedDate not supplied

[Restoration of duodenal transit in the surgical treatment of postgastrectomy syndrome. The Soupault-Bucaille procedure].

Between 5-50% of patients undergoing gastric resection still develop postgastrectomy syndrome in spite of the development of surgical techniques and an improved knowledge of gastrointestinal physiopathology: unfortunately, 2-5% of these patients require surgery. The technique to be used depends on a careful clinical and instrumental evaluation aimed at identifying the dominant type of postresection syndrome and any associated lesions, on the previous operation and obviously on the intraoperative situation. Soupault-Bucaille's gastroduodenojejunoplasty aims to correct the postresection syndrome by reinserting the duodenum in the digestive circuit, interposing between it and the gastric stump a jejunal loop made from the efferent (or afferent in the case of Billroth II with efferent on the lesser gastric curvature). This reconstitutes a paraphysiological condition of the digestive circuit, reduces biliary reflux and resolves acute gastritis. It is indicated in patients affected by early or late dumping syndrome, or multi-deficiency syndromes that do not respond to pharmacological therapy. The presence of concomitant biliary reflux is not a contraindication for this procedure, but confirms the need. Roux-en-Y is able to produce better results in postgastrectomy syndromes with alkaline gastritis and/or esophagitis sustained by biliary reflux, gastric atonia and afferent loop syndromes.

Dumping Syndrome↗
PubMed1979

[Pathogenesis, clinical manifestations and treatment of the "postgastrectomy-syndrome" (author's transl)].

The incidence rate of complications in patients, who underwent stomach resection as surgical treatment procedure is rather high (20%). Postprandial syndromes (dumping syndrome, lactose-intolerance, afferent loop-syndrome), malabsorption syndromes (anemia, osteopathia, steatorrhea, protein deficiency) and late organic manifestations (anastomotic and suture ulcers, retrograde intussusception, gastric-stump carcinoma) were usually summarized as "postgastrectomy syndrome". A review of pathogenesis, symptoms and therapeutic approach for the various postoperative disorders is given. Selective proximal vagotomy as the surgical treatment procedure of choice is emphasized.

Afferent Loop Syndrome↗
PubMedDate not supplied

[Antiperistaltic duodenojejunal pouch in the reconstruction of digestive transit after subtotal, total gastrectomy and in the postgastrectomy syndrome. Technic].

A new technic for reconstruction of the digestive tract after total and subtotal gastrectomy in patients with BII postgastrectomy syndrome is proposed. This technic is based on: 1) the to-and-from motion of the barium inside the duodenal arch, and 2) the duodenogastric reflux, both observed in X-ray examinations in normal and in patients bearing gastroduodenal ulcers. The advantage of this technic is to associate the inverted Y en Roux with an interposition of a small bowel segment, besides a reservoir with dynamic function which is obtained using the duodenal arch, as well as 10 cm of jejunum, where the ingested food is mixed with the digestive secretions and is eliminated with antiperistalsis, without stasis. From 1977 to 1983, 36 patients were operated on with the above mentioned technic. Ten of them were admitted to total gastrectomy, 16 to subtotal gastrectomy, 7 to minimal radical gastrectomy and three to postgastrectomy syndrome.

Adult↗
PubMed1978

[Postgastrectomy syndromes. Development of the aspects in past and present (author's transl)].

After gastric operations about 20 to 30% of all patients complain of an abundance of postoperative gastrointestinal and vasomotor complaints. Research into these "postgastrectomy syndromes" is carried out periodically. In the beginning of this century concepts as precipitated evacuation, dumping stomach, too narrow or too wide anastomosis predominate. In the thirties the subdivision into a so-called early and late dumping syndrome follows. The description and treatment of the afferent loop syndrome in the middle of this century suggest the introduction of functional factors into the explanation of the postgastrectomy syndromes. Next comes the recognition of the pathophysiological significance of the regurgitated duodenal contents into the operated stomach. The endoscopic biopsy gives a broad morphological basis. The postoperative alcaline reflux gastritis temporarily ends the development.

Bile↗
PubMed1981

Postgastrectomy syndromes.

The preceding briefly summarizes some mechanical, metabolic, and motility disturbances that develop after gastric operations. Clearly, the more thorough the search and questions, the greater the incidence of minor, moderate, or severe impairment by one or more of these disorders. Our previous fears in treating benign ulcer disease were, first, mortality and, then, recurrent ulcers. Postgastrectomy syndromes were thought of secondarily. The seriousness, frequency, and lack of specific treatment available for most postgastrectomy syndromes were generally not recognized. While serious sequelae are infrequent, some take years to develop. A few, such as cancer, are regrettable even if treatable. Surgical correction of most of these syndromes is at best 50 to 80 percent effective. Poor selection of patients, mixed symptoms, and our inability to repiece vagus nerves and excised antrums make it difficult, if not impossible, to correct totally the anatomic and physiologic changes. Surgical intervention is infrequent. For some abnormalities, such as bile reflux gastritis, correction is uniformly good if gastric emptying is satisfactory and the syndrome exists alone. For others, such as dumping and diarrhea, treatment is less exacting, and the variety of operative alternatives often confuses rather than helps. My own continually changing experiences have taught me to correct the major disability in the simplest way. My experience with take-down of gastrojejunostomies and pyloroplasties is limited but encouraging. My satisfaction with Roux-en-Y conversions of Billroth II resections in reflux gastritis has been extended to the correction of diarrhea and dumping. Creating a long isoperistaltic limb between stomach and jejunum has provided surprisingly excellent relief for the problems of rapid emptying, although I have not objectively verified emptying changes in all successfully treated patients. The best results come with avoidance of these disorders. It is hoped that simpler operations for ulcer disease will continue to gain in popularity. Highly selective vagotomy is an easier, more attractive alternative than any of the aforementioned remedial procedures, particularly if the long-term results are good.

Afferent Loop Syndrome↗