[Gastric surgery].

Abstract

Clinical and experimental studies related to gastric surgery in the First Department of Surgery, Niigata University Hospital are reported in this paper. For the curative resection of cancer which is located in the upper one-third of the stomach and infiltrates into the esophagus, gastrectomy with distal pancreatectomy and splenectomy is necessary in order to remove the lymph nodes around the splenic artery and hilum completely, and sufficient resection of the thoracic esophagus and removal of lymph nodes around the thoracic esophagus and diaphragm are also important. Postoperative G cell hyperplasia of the antral mucosa and consequent increased gastrin release are probable causes of recurrent ulcer after selective proximal vagotomy for duodenal ulcer. It is known that selective vagotomy with antrectomy for duodenal ulcer has scarcely shown recurrent ulcer but frequently accompanies gastric stasis in the early postoperative period. However, frequency of postoperative gastric stasis can be reduced by the preservation of right gastro-epiploic vessels and nerves around them during operative procedure of antrectomy. In conclusion, it is emphasized that not only seeking after radicality of operation but also minimizing postoperative disturbances and preserving gastric function as much as possible are essential in gastric surgery.