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At least 145 records · Page 8Linked to original sources

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↗

PubMed1976

Alkaline reflux gastritis.

Any surgical procedure that ablates the pyloric sphincter mechanism permits increased reflux of duodenal fluid into the stomach or gastric remnant. Although it is reported as most common with Billroth II gastrectomy, our experience indicates that reflux is nearly as frequent after Billroth I gastroduodenostomy and is not at all infrequent after pyloroplasty. The precise constituents of duodenal fluid which damage the gastric mucosa remain controversial. The best present evidence is that the bile acids are probably essential, but that one or more other constituents of duodenal content are also necessary. The clinical history differs significantly from chronic afferent loop syndrome in that the quality of pain is different, pain tends to be more continuous and less closely related to food-taking, and bile vomiting does not provide dramatic relief, often containing food due to coexistent interference with gastric emptying. Diagnosis is confirmed by gross endoscopic findings and characteristic histopathologic changes in the endoscopic biopsies. Treatment with an interposed isoperistaltic jejunal segment has been disappointing. Only four of ten patients experienced lasting relief, indicating that the relatively short 10 to 12 cm. of jejunum does not adequately prevent duodenogastric reflux. We have, therefore, shifted to the Roux-en-Y duodenal diversion implanting the afferent limb 40 cm. caudad to the gastrojejunostomy. Results have been excellent in 24 of 25 cases with prompt improvement in gastric emptying, absence of bile vomiting, progressive regression in abdominal distress and progressive improvement in nutrition. Endoscopic evaluation at three to four months has indicated marked gross improvement and striking histologic improvement in 23 of 25 cases. The question is raised whether the Roux-en-Y reconstruction should not be used primarily, particularly if both vagotomy and antrectomy are to be performed for peptic ulcer. Both the afferent loop syndrome and alkaline reflux gastritis would be prevented, and it is doubted that the incidence of marginal ulcer would increase appreciably.

Afferent Loop Syndrome↗

PubMedDate not supplied

Percutaneous transhepatic insertion of metal stents with a double-pigtail catheter in afferent loop obstruction following distal gastrectomy.

We report successful outcome following transhepatic insertion of metal stents with a double-pigtail catheter in a patient with afferent loop syndrome caused by recurrent gastric carcinoma. A 77-year-old man was admitted with a 2-week history of fever, right upper quadrant pain, and jaundice. His past medical history included distal gastrectomy for treatment of gastric cancer two years previously. Abdominal computed tomography revealed marked dilation of the jejunal limb and intrahepatic bile duct. We diagnosed the patient with afferent loop syndrome resulting from recurrent cancer. Percutaneous transhepatic biliary drainage was performed, and a catheter was placed beyond the papilla of Vater. Approximately 1300 mL of turbid jejunal contents were removed. Symptoms resolved by one day after initiation of drainage. After 1 week, a sheath introducer was inserted beyond the point of stenosis, and two metal stents were placed. A double-pigtail catheter was inserted into the metal stents to prevent migration. Good stent placement was confirmed and the drainage catheter was removed.

Afferent Loop Syndrome↗

PubMed2006

Enteroliths developed in a chronically obstructed afferent loop coexisting with gastric remnant carcinoma: Case report and review of the literature.

A case of gastric remnant carcinoma coexisting with a chronic afferent loop syndrome harboring multiple enteroliths in a grossly dilated and elongated afferent loop is presented herein. The patient had undergone a Polya type antecolic Billroth II reconstruction for a stenosing duodenal ulcer 40 years previously. A concise review of the relevant literature is also presented.

Afferent Loop Syndrome↗

PubMed1976

Disability after gastric surgery.

Partial gastrectomy, truncal vagotomy, pyloroplasty, and gastrojejunostomy, singly and in combination, produce clinical disturbances in gastric reservoir function, gastric emptying, gastric mucosal integrity, small intestinal motility, and small intestinal fluids shifts. Ordinarily, these disturbances are of minor clinical importance and respond readily to conservative management. However, postoperative gastric surgical symptoms are, at times, annoying or disabling to the patient. Some of these clinical states are amenable to surgical treatment, and in others, operative intervention is definitely contraindicated. Therefore, it is important to recognize those syndromes which are amenable to an operative procedure. Alkaline gastritis, a syndrome of postcibal pain and diffuse endoscopic gastritis with or without vomiting of bile, is best treated by vagotomy and Roux-en-Y gastrojejunostomy. The afferent loop syndrome of relief of pain by vomiting and the demonstration of a dilated or tortuous afferent loop is likewise best treated by vagotomy and Roux-en-Y gastrojejunostomy or enteroenterostomy. Efferent loop obstruction causing vomiting and gastric distention requires a revision of the gastrojejunostomy. The dumping syndrome is best treated conservatively for at least a year. If this approach fails, loop reversal at the stoma or conversion of a Billroth II to a Billroth I anastomosis is effective. For postvagotomy diarrhea, loop reversal in the distal jejunum gives relief, and for the postvagotomy atonic stomach, a subtotal gastrectomy should be performed after failure of conservative management, although there is not enough experience with this condition to make accurate prognoses. Beware of the patient who does not fit any of these syndromes. A poor result is likely to follow attempts at surgical correction.

Afferent Loop Syndrome↗

PubMed1995

[Surgical treatment of diseases of operated stomach].

Surgical treatment of 293 patients with diseases of an operated on stomach is analysed. Relapse of peptic ulcer after closure of a perforation was encountered in 170 patients, the dumping syndrome in 54, peptic ulcer of the anastomosis in 60, the afferent loop syndrome in 6, and a rare type of diseases of an operated on stomach in 3 patients. Classification of diseases of an operated on stomach according to the syndromes and differential diagnosis of functional syndromes are presented. Indications for surgical correction depending on the type and severity of the pathological condition were developed. The late-term results were studied in 266 patients. The results were good in 72%, satisfactory in 21%, and poor in 7% of cases. The late-term results in surgical correction of functional syndromes were good in 29%, satisfactory in 51.6%, and poor in 13.5% of patients. Mortality after all repeated operation was 1.3%.

Afferent Loop Syndrome↗

PubMed2006

Malignant afferent loop obstruction following pancreaticoduodenectomy: report of two cases.

We report two cases of malignant afferent loop obstruction following pancreaticoduodenectomy (PD). Case 1. A 70-year-old woman, who had undergone PD for pancreatic cancer, was referred to our hospital because of fever, jaundice, and abdominal pain. Ultrasonography and abdominal computed tomography demonstrated dilatation of a small bowel loop in the right upper quadrant. Laparotomy confirmed the diagnosis of local recurrent tumor causing occlusion of the afferent limb, and Roux-en-Y bypass was performed. Case 2. A 72-year-old man, who had undergone PD for cancer of the major papilla, was hospitalized with a high-grade fever and epigastric pain. Ultrasonography and abdominal computed tomography revealed a dilated afferent loop and multiple masses in liver. At laparotomy, widespread carcinomatosis was found to have caused afferent loop obstruction, and surgical bypass was performed. In conclusion, the surgical bypass seems to be an effective palliative treatment for afferent loop syndrome after PD.

Afferent Loop Syndrome↗

PubMedDate not supplied

Septic shock after percutaneous transhepatic drainage of obstructed afferent loop: case report.

For management of the afferent loop syndrome, surgical revision such as jejunojejunostomy or Roux-en-Y conversion is the established procedure. Percutaneous transhepatic catheter drainage was used as a method of palliative treatment of the obstructed afferent loop in a patient with extensive mesenteric and peritoneal dissemination of gastric cancer. There were no procedural-related complications, but severe bacterial cholangitis and septicemia occurred later. Our limited experience indicates that this procedure may be risky, and that an additional drainage catheter of the bile duct may be needed when biliary stasis is present.

Afferent Loop Syndrome↗

PubMed1979

The pathophysiology of gastric surgery.

Gastric surgery may be followed by mechanical postoperative problems, usually due to impaired gastric emptying or the afferent loop syndrome, recurrent dyspepsia, the early or late dumping syndrome, diarrhoea, or nutritional disturbances. The pathophysiological basis of these disorders is discussed and their clinical features are briefly considered.

Acute Disease↗

PubMedDate not supplied

Laparoscopy in afferent loop obstruction presenting as acute pancreatitis.

BACKGROUND: We describe an afferent loop obstruction caused by an adhesion band in a case of distal gastrectomy with Roux-en-Y end-to-side jejunal anastomosis for cancer. METHODS: An initial clinical presentation of acute pancreatitis was ruled out by a computed tomography scan, which revealed intestinal obstruction; it was then confirmed on laparoscopy. Definitive treatment was laparoscopic adhesiolysis. A complete review of the literature concerning afferent loop obstructions is presented. RESULTS: The treatment was successful, with minimal postoperative pain, and the 5-day hospital stay was uncomplicated. The patient remains asymptomatic at 1-year follow-up. CONCLUSIONS: The authors advocate minimally invasive surgery as a complete diagnostic and therapeutic alternative to emergency laparotomy in cases where afferent loop syndrome is suspected, and acknowledge that prompt surgery has a higher rate of success and reduces operative morbidity and mortality.

Acute Disease↗

PubMedDate not supplied

[Afferent loop obstruction after total gastrectomy presenting as acute pancreatitis (clinical contribution to the etiopathogenesis)].

Afferent loop obstruction presenting as acute pancreatitis is an uncommon pathology encountred after total gastrectomy or gastric resection. The authors refer about a case of afferent loop syndrom presenting as acute pancreatitis, and conclude that, since this disease is very rare, aggressive and variable, its diagnosis and therapy is still controversal.

Acute Disease↗

PubMed1990

[Correction of chronic disorders of duodenal patency in the prevention of postoperative complications of peptic ulcer].

Experiments on dogs demonstrated the role of chronic disorders of duodenal patency (ChDDP) in the development of immediate and late-term postoperative complications of gastric and duodenal ulcer, like incompetence of the duodenal stump, reflux gastritis, progression of duodenostasis existing before the operation, the afferent loop syndrome, postresection cholecystitis and pancreatitis, the dumping syndrome. The formation of valvar anastomoses and early recognition and correction fo ChDDP in resection of the stomach (554 patients) made it possible to reduce significantly both the mortality rates (0.18%) and the percentage of other complications.

Afferent Loop Syndrome↗

PubMed1983

Technical complications of Roux-en-Y gastrojejunostomy.

The Roux-en-Y gastrojejunostomy has become an increasingly popular technique for gastrointestinal tract reconstruction since it is purported to obviate many of the classic complications of the Billroth II gastrojejunostomy. In a review of over 900 Roux-en-Y gastrojejunostomies, seven patients with complications mimicking those seen with Billroth II reconstruction were identified. These complications included duodenal stump blowout, proximal blind loop or afferent loop syndrome, and bile-reflux gastritis. These complications resulted from technical problems in construction of the Roux-en-Y. Once the complications were diagnosed, they were amenable to operative correction. Recognition of the potential for these complications following Roux-en-Y gastrojejunostomy should aid in early diagnosis and treatment.

Adult↗

PubMedDate not supplied

A woman with abdominal pain and bilious vomiting. A very late aftermath of Billroth II gastrectomy.

Patients with a history of Billroth II gastrojejunostomy who present with a symptom complex of postprandial nausea, fullness, and bilious vomiting leading to relief should be suspected of having an afferent loop syndrome. Diagnosis depends on barium radiography and upper intestinal endoscopy. Surgical correction is the treatment. The current age of medical therapy has dramatically decreased the frequency and necessity of surgery for peptic ulcer disease. However, we should not forget the lessons of the past and fail to diagnose a patient who has a chronic complication of a previously common operation.

Abdominal Pain↗

PubMed1977

[Hepato-biliary-pancreatic lesions in secondary duodenostasis].

The secondary postoperative duodenal stasis (afferent loop syndrome, chronic vicious circle) is underlain by evacuational disturbance of the duodenum. The duodenal stasis and hypertension lead to the stasis of the bile and pancreatic-secretion, which in turn results in inflammatory-dystrophic changes in the hepato-biliary-pancreatic system. In such cases the success of surgical treatment will derive from the application of complex intervention both on the digestive tract and hepato-biliary system.

Afferent Loop Syndrome↗

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↗

PubMed1983

[Ulcer risk caused by reflux prevention? Results of jejunal interposition].

The results of isoperistaltic jejunal interposition in reconstructive ulcer surgery are demonstrated on the basis of 62 patients, operated one and a half to nine years ago. The operations had been done because of dumping, reflux gastritis and afferent loop syndrome. Now 38 (65.5%) of the followed-up patients had a Visick I or II grading, 16 (27.5%) were Visick III. The endoscopical gastric mucosal biopsy showed normal mucosa as well as superficial gastritis or atrophic gastritis in different patients. By comparison with the preoperative biopsies no protective effect of the bile diversion on the gastric mucosa could be demonstrated. On the contrary 12 of 58 patients (20.5%) developed stomal ulcerations, which were often asymptomatic, mostly superficial and in 8 cases had to be operated in the meantime. The gastric acidity analysis showed a low gastric output with low pH values (pH 2.7--3.4). The incidence of stomal ulceration in jejunal interposition seemed to correlate with the reflux preventive effect. The longer the segment and the better the reflux preventive effect were, the higher was the ulcer risk. The parallelity of reflux preventive ulcer surgery and the ulcer provocation by the Mann-Williamson experiment is demonstrated. Therefore reflux preventive surgery should be used very carefully and in reconstructive procedures only. Using the jejunal interposition the segment should not be longer than 12--15 cm and a vagotomy has always to be added.

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↗