Post-gastrojejunostomy entero-gastric reflux: is it always Symptomatic?

Evaluation of the problem of enterogastric reflux in duodenal ulcer patients managed by anterior and posterior truncal vagotomy and simple loop gastrojejunostorny. Between September 1976 and May 1996, 709 duodenal ulcer patients were managed by different surgical techniques. Anterior and posterior truncal vagotomy with simple loop gastrojejunostomy were done for 372 patients [52.5%]. Of the last group, 75 random patients were studied for enterogastric reflux. The mean postoperative period was 6.5 years, the mean age was 43 years, 64 were men and 11 were women. Careful clinical examination, barium meal study and esophagogastroscopy with histological examination of multiple gastric biopsies were done for all patients. Dual channel simultaneous esophageal and gastric 24h pH monitoring was done for 28 patients. Patients were classified into 2 groups, group 1 included 44 patients [58.7%] free of symptoms and group 2 included 30 patients [40%] who complained of one or more symptom of gastritis, however, the classic symptoms of alkaline refiux gastritis were found only in 8 patients [10.7%]. One patient [1.3%] was excluded due to proved ulcer recurrence. Endoscopic evidence of gastritis was found in 50% in group I versus 73.3% in group 2 [P<0.05]. Histopathologic evidence of gastritis was found in 77.3% in group 1 versus 46.7% in group 2 [P=0.007]. PH monitoring revealed alkaline gastric reflux in 50% in group I versus 75% in group 2 [P>0.05] alkaline esophageal reflux in 33.3% in group 1 versus 50% in group 2 [P<0.05] and mixed esophageal reflux [i.e alkaline and acidic] in 16.7% in group 1 versus 18.8% in group 2 [P> 0.05]. Enterogastric refiux is not an infrequent problem after trurcal vagotomy and loop gas trogejunostory. Pathologic alkaline gastric reflux should be proved by endoscopy, histopathology and pH metry before deciding remedial surgery

Laparoscopic cholecystectomy: a recent experience

A long the period from October 1992 to July 1993, 162 consecutive patients with gall stones were considered for laparoscopic cholecystectomy in the Gastroenterology Center of Mansoura. 106 females and 56 males, their ages ranged from 23 to 65 years. All the patients underwent ultrasonic abdominal examination, complete laboratory, chest and cardiac assessment. E.R.C.P., papillotomy and stone extraction when needed was done in cases with history [or] of jaundice before the procedure. Cardiac and hypertensive patients were excluded from the study. Laparoscopic cholecystectomy was successful in 135 out of the 262 cases [83.3%]. 27 cases failed to be completed by laparoscopy [16.7%], 5 cases were due to uncontrollable bleeding, 3 from injured cystic artery and 2 from cirrhotic liver. The other failures were due to marked dense adhesions with acutely inflammed gall bladder in 9 cases, injury of common bile duct in 2 cases, injury of gall bladder with escape of multiple small stones intra-abdominally in 2 cases, 5 cases gall bladder masses, failure to grasp or manipulate thick walled gall bladders that were packed with multiple small stones in 2 cases, presence of cholecysto-duodenal fistula in one case and injury of the right common iliac vessels by the trochar in one case. There were no deathes, but post-operative major complications occured in 4 cases that needed laparotomy, 2 cases of internal haemorrhage and 2 cases of biliary peritonitis. There were 6 minor complications, 3 surgical emphysema, and 3 small collections in gall bladder bed, that all passed conservatively. The shortest time of the procedure was 20 minutes and the longest was 3 hours. The median post-operative stay was 2 days and all the patients could start oral diet in the morning of the second day. In Conclusion, from this recent experience and results. We could suggest what are the possible difficulties and complications that could be met with laparoscopic cholecystectomy and we suggest that it should tried in most of patients who require elective or urgent cholecystectomy specially if radiological and endoscopic support are available

Parietal cell vagotomy [P.C.V.] 15 years experience

Along 15 years, 106 patients had elective parietal cell vagotomy for duodenal ulceration. Ninty nine patients have complete follow up from 12 months to 15 years. Of those, 42 patients had surgery over 10 years ago and 35 patients survived for more than 10 years. There was no hospital mortality. Gastric stasis recorded early in 3 cases [3%] and 2 of them required reoperation in 2 patients splenectomy was required as a result of operative trauma. Mild dumping occured in 2 cases [2%] and mild diarrhea in other 2 cases, 40 cases suffered from early mild and transient [40.4%] dysphagia. From 2-10 years after surgery, thirty patients [30%] have had recurrent ulceration. In seven [7%] of these cases the recurrence was asymptomatic. The overall clinical results by using modified Vi-sick's were excellent and very good in 66.4% of cases and unsatisfaction in 33.6%