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At least 37 records · Page 2Linked to original sources
PubMed2003

Pathophysiological studies on the relationship between postgastrectomy syndrome and gastric emptying function at 5 years after pylorus-preserving distal gastrectomy for early gastric cancer.

Pylorus-preserving distal gastrectomy (PPG) has frequently been performed on patients with early gastric cancer in Japan to prevent the postgastrectomy syndrome seen after conventional distal gastrectomy (CDG). The long-term postoperative quality of life (QOL) and gastric emptying function in patients after PPG has not been assessed in detail. To clarify the usefulness of PPG for treating early gastric cancer we investigated the relation between postgastrectomy syndrome and gastric emptying function 5 years after PPG and then compared the results with those 5 years after CDG. Altogether, 32 patients who underwent curative gastrectomy at our clinic for early gastric cancer (submucosal cancer without lymph node metastasis) were studied. Ten subjects who underwent PPG with D2 lymphadenectomy without preserving the hepatic and pyloric branches of the vagal nerve [group A: eight men, two women; age 33-70 years (mean 60.7 years)] were interviewed and asked about appetite, weight loss, epigastric fullness, reflux esophagitis, and early dumping syndrome. They were compared with patients after CDG [group B: 36-72 years (mean 63.6 years)]. Esophagogastric endoscopy, abdominal ultrasonography, and gastric emptying function were also studied. The gastric emptying time of a semisolid diet was measured with a radioisotope method using (99m)Tc-labeled rice gruel; the gastric emptying time of a liquid diet was measured with the acetaminophen method using orange juice. The control subjects (group C) consisted of 18 healthy volunteers (10 men, 8 women) without gastrointestinal symptoms aged 38 to 68 years (mean 60.8 years). The following results were obtained: PPG (group A) alleviated postoperative gastrointestinal symptoms such as appetite loss, reflux esophagitis, early dumping syndrome, lost body weight, endoscopic reflux esophagitis, endoscopic gastritis in the remnant stomach, and postogastrectomy cholecystolithiasis better than did CDG (group B). The only weak point with the PPG procedure was that it produced a feeling of epigastric fullness. The pattern of the gastric emptying curve for the semisolid diet was almost the same among groups A, B, and C, although delayed gastric emptying was clearly more frequent in group A than in group B or C ( p < 0.05). Gastric emptying with the liquid diet in group B was significantly faster than that in groups A and C ( p < 0.01). Gastric emptying in groups A and C was similar. These results showed that PPG improved the postoperative QOL, but the delayed emptying of semisolid diet after PPG led to a feeling of epigastric fullness after meals due to retention of contents in the residual stomach. Epigastric fullness after meals continued in many patients after PPG. Thus the only disadvantage of the PPG procedure is the sensation of epigastric fullness and gastric stasis due to delayed gastric emptying of a semisolid diet.

Adult↗
PubMed1990

Management of postgastrectomy syndromes.

There is still much to learn about the cause of postgastrectomy syndromes. Fortunately, most patients can be managed by conservative measures unless a mechanical cause, amenable to operative correction, is found. Thus, it is important to determine the type of postgastrectomy problem that is affecting the patient. In carefully selected patients, remedial operations may ameliorate the patient's symptoms and permit him or her to return to a normal lifestyle. Humoral factors have attracted increasing attention, especially in patients with the dumping syndrome. The somatostatin analogue octreotide has provided relief from the vasomotor and gastrointestinal symptoms of severe dumping but must be given three to four times a day by injection.

Afferent Loop Syndrome↗
PubMed1979

The use of stapling devices in the management of postgastrectomy syndromes.

By the use of the stapling devices, a large spectrum of postgastrectomy syndromes can be managed with minimal manipulation and dissection, shortened operative time, decreased blood loss and spillage, and reduced morbidity while attaining uniformly good amelioration of symptoms. As others have recommended, the application of these techniques at the primary procedure should be considered. The author's experience in ten primary procedures has been quite gratifying to date.

Esophagus↗
PubMed1975

Surgical treatment of late postgastrectomy syndromes.

An analysis of the experience at the University of California Hospital, San Francisco, with the diagnosis and treatment of fifty-nine postgastrectomy syndromes shows that stomal obstruction (sixteen patients), the most common syndrome, was best treated by total reconstruction rather than stomal revision. Disappointment with the results of other procedures for the dumping syndrome (50 per cent improvement) has convinced us of the need to adopt the use of reversed jejunal interposition for surgical treatment of this condition. Because a precise etiologic diagnosis of bilious vomiting is often elusive, the preferred procedure is isoperistaltic jejunal interposition, since it eliminates the afferent loop and prevents bile from entering the stomach. All five patients with malabsorption were improved by conversion from BII to BI. Four of five patients with diarrhea were improved by various procedures (not including a reversed segment of intestine in the midjejunum). Three patients with reflux alkaline gastritis were improved by Roux-en-Y gastrojejunostomy or isoperistaltic jejunal interposition. Either is effective. Thus, in our experience if an unquestionable diagnosis of stomal obstruction, malabsorption, or reflux alkaline gastritis can be established, there is ample justification for an optimistic outlook regarding surgical therapy.

Adult↗
PubMed1991

The Roux operation for postgastrectomy syndromes.

The aim of this paper is to describe the technique, indications, and results of the Roux operation as used in the treatment of postgastrectomy syndromes. A Roux gastrojejunostomy with a 40-cm Roux limb is the procedure of choice for alkaline reflux gastritis, because it virtually eliminates reflux of bile and pancreatic juice into the stomach. The slow transit through a Roux limb can also be used to good advantage to slow gastric emptying in patients with dumping. Patients with delayed gastric emptying respond to the combination of near-total gastric resection, which removes the atonic gastric remnant and speeds emptying, and Roux-Y gastrojejunostomy, which prevents reflux esophagitis and provides a reservoir for ingesta in the upper gut. After all Roux operations, however, the Roux limb may slow emptying so much that pain, fullness, nausea, and food vomiting result, the so-called Roux stasis syndrome. Prevention of the Roux stasis syndrome with an "uncut" Roux limb and the treatment of the syndrome by using electrical pacing to suppress the ectopic pacemakers that emerge in the limb offer possible new solutions to this vexing problem.

Anastomosis, Roux-en-Y↗
PubMed1994

Postgastrectomy syndromes: dumping and diarrhea.

This article reviews the current literature on the postgastrectomy syndromes of dumping and postvagotomy diarrhea. Pathophysiology, diagnosis, incidence, and treatment options are discussed. These syndromes present some of the most difficult treatment dilemmas seen after surgery. Specific recommendations for both medical and surgical treatments are included.

Diarrhea↗
PubMed1993

The value of sham-feeding tests in patients with postgastrectomy syndromes.

OBJECTIVE: The value of gastric secretory testing in surgical practice has been questioned. Sham feeding (SF) is a test of gastric secretion that determines the status of gastric vagal innervation or incomplete vagotomy. Our purpose was to show that the results of SF tests affect operative strategy and/or clinical management. DESIGN: The medical records of 30 consecutive patients studied with SF in our laboratory were reviewed to determine if patient management was affected by the results of SF. PATIENTS: All 30 patients had prior vagotomies. Sham feeding was performed in patients (1) before planned reoperation for postgastrectomy syndromes (n = 17), (2) with peptic ulcerations/pain of unclear etiology (n = 8), or (3) postoperatively in those who were at high risk for recurrent ulcer (n = 5). RESULTS: Sham feeding indicated complete vagotomy in 16 patients and incomplete vagotomy in 14 patients. In 17 patients studied before planned reoperation, operative strategy was affected by results of SF in 15 cases; five patients had revagotomies performed at reoperation, 11 did not, and one patient had her operation canceled. In patients with atypical postoperative ulcers/pain, management was changed in only two of eight patients. In the high-risk patients studied postoperatively, management was affected in four of five patients. CONCLUSIONS: (1) We believe that our results justify the performance of SF before any reoperation on the stomach, since an operative plan was nearly always affected. (2) In patients with atypical peptic complaints after gastric surgery, SF usually (80%) confirmed acid hypersecretion, thereby affecting management less often. (3) Although unproved, we believe SF results can guide the use of "prophylactic" H2-blockers in treating selected high-risk postgastrectomy patients.

Adult↗