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Formic acid is an easily available substance and can thus be consumed voluntarily or accidentally. Here is a case who presented to our center 5 days post accidental ingestion of formic acid. He had developed acute renal failure requiring hemodialysis. Post admission he had altered sensorium probably alcohol withdrawal and later aspiration pneumonia and ARDS. He developed a late onset GI bleed on day 8 of ingestion with significant hemoglobin drop. An emergency endoscopy was done which showed a normal esophagus but extensive corrosive damage and active bleeding from gastric area. He continued to have drop in hemoglobin in-spite of aggressive volume and blood product transfusions. He was taken up for an emergency subtotal gastrectomy and viable tissue was demarcated with intraoperative endoscopy and a subtotal gastrectomy was performed. He stabilized initially but worsened again 2 days later with worsening lactic acidosis and succumbed to his illness. The fact that esophagus was completely spared with extensive involvement of stomach could possibly indicate a need for review of initial management of corrosive/organic acid poisoning.
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Objective To explore risk factors for infection after subtotal gastrectomy in patients with gastric cancer, and provide reference for prevention of infection.Methods Clinical data of gastric cancer patients who were admitted to a hospital from July 2010 to June 2014 for subtotal gastrectomy were analyzed retrospectively, related factors for post-operative infection were explored.Results A total of 210 gastric cancer patients who underwent subtotal gastrectomy were enrolled, 36 patients had healthcare-associated infection (HAI) after operation, incidence of HAI was 17.14％, the main HAI were abdominal infection (n=10) and surgical site infection (n=9).Univariate analysis showed that incidence of post-operative infection was higher in gastric cancer patients who were older than 55 years, malnutrition, laparotomy, tumor-nodes-metastasis (TNM) stageⅢ-Ⅳ, and bedridden time＞4 days after operation (all P＜0.05).Logistic regression analysis showed that patients' age＞55, malnutrition, and laparotomy were independent risk factors for infection after subtotal gastrectomy (all P＜0.05).Conclusion Old age, poor nutritional status, and laparotomy are risk factors for infection after subtotal gastrectomy in patients with gastric cancer, effective prevention and control measures should be formulated according to these factors before and after operation.
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Gastric remnant necrosis after a subtotal gastrectomy is an extremely uncommon complication due to the rich vascular supply of the stomach. Despite its rareness, it must be carefully addressed considering the significant mortality rate associated with this condition. Patients vulnerable to ischemic vascular disease in particular need closer attention and should be treated more cautiously. When gastric remnant necrosis is suspected, an urgent endoscopic examination must be performed. We report a case of gastric remnant necrosis following a subtotal gastrectomy and discuss possible risk factors associated with this complication.
Subject(s)
Humans , Endoscopy , Gastrectomy , Gastric Stump , Ischemia , Mortality , Necrosis , Risk Factors , Splenic Infarction , Stomach , Vascular DiseasesABSTRACT
The hematogenous spreading of an infectious pathogen via the portal vein from a mucosal injury in the gastrointestinal tract has been considered as one of the pathologic mechanisms of pyogenic liver abscess. Several studies have presented the association between colorectal cancer and pyogenic liver abscess. However, the cases of stomach cancer concomitant with pyogenic liver abscess have rarely been reported in the world. Herein, we present a case of advanced gastric cancer concomitant with pyogenic liver abscess in a patient who previously underwent subtotal gastrectomy due to peptic ulcer perforation.
Subject(s)
Humans , Colorectal Neoplasms , Gastrectomy , Gastrointestinal Tract , Liver Abscess, Pyogenic , Peptic Ulcer Perforation , Portal Vein , Stomach NeoplasmsABSTRACT
Objective To explore the feasibility of gastroesophagostomy when patients with esophagus carcinoma com bined with stomach carcinoma.Methods In March 2011 to May 2016,our department completed with the method of genera tion of esophagus stomach in the treatment of esophageal cancer merger 18 cases of gastric cancer patients.Age 52-67,16 ca ses of esophageal lesions located in the middle section,2 cases located in the chest.4 cases were gastric lesions located in the proximal stomach,14 cases were located in the distal stomach Four kinds of surgical methods can be chosen from.Proximal or distal stomach could be used to replace esophagus and the blood supply came from left gastric artery or right gastroepiploic artery.Stomach tissue separation and reverse gastric tube were used if the length of stomach was insufficieut.Results When resection of esophageal and gastric carcinoma were accomplished simultaneously,residue stomach can be used as a replacement of esophagus if patients were rigidly selected.Conclusion Residue stomach was a good substitute after radical resection of esoph agus and gastric dual-source carcinoma.Patients chosen and surgery design were both important.
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Objective To explore the application effect of individualized traditional Chinese medicine nursing mode in the nursing of patients with subtotal gastrectomy. Methods A total of 60 eligible patients who met the standard were divided into the control group and the intervention group with 30 cases in each group according to the random number table method, the control group received only normal nursing while the intervention group was subjected to the individualized TCM nursing based on the normal nursing. The nursing effect was compared between two groups. Results Scores of negative mood of patients of the intervention group before surgery, electrogastrogram slow wave 3 h, the first day and the second day after the operation, first feeding time after operation, early ambulation time, average length of stay was (16.50 ± 3.20) points, 2.58 ± 0.46, 2.88 ± 0.08, 2.99 ± 0.54, (28.70 ± 4.43) h, (29.09 ± 4.55) h, (8.24 ± 1.38) d. The control group was(16.98 ± 2.61)points, 2.40 ± 0.53, 2.79 ± 0.14, 2.71 ± 0.30,(31.45 ± 3.80)h,(32.91±2.28)h,(10.40±1.99)d, there were significant differences between the two groups (t=2.53-25.19, P 0.05). Conclusions Individualized TCM nursing can effectively alleviate the patients′ negative mood, shorten the recovery time of postoperative electrogastrogram slow wave, first feeding time and early ambulation time, to restore the gastrointestinal function of patients earlier, effectively promote the rehabilitation of patients;at the same time, shorten the hospitalization time.
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Objective To analyze the influence of different digestive tract reconstruction methods on blood sugar in T2DM patients after subtotal gastrectomy,and to explore the possible mechanism.Methods The clinical data of 64 cases of T2DM patients undergoing subtotal gastrectomy because of gastric ulcer or cancer were retrospectively analyzed.They were divided into Roux-en-Y group (34 cases) and Billroth Ⅱ group (30 cases) according to the different reconstruction methods of digestive tract,and they were treated by Roux-en-Y anasto-mosis and Billroth Ⅱ anastomosis respectively after subtotal gastrectomy.They were followed up for 6 months.BMI,fasting blood sugar,2 h postprandial blood glucose,glycosylated hemoglobin,fasting insulin,insulin resistance index (HOMA-IR),glucagon peptide 1 (GLP-1),gastric inhibitory peptides (GIP),and GIP/GLP-1 before surgery and one week,one month,3 months,and 6 months after surgery were compared between the two groups.Results BMI of the two groups 3 months,and 6 months after surgery was significantly lower than those before surgery (P＜0.05),and it had no statistical significance between the two groups at the same time point (P＞0.05).Compared with preoperative,the fasting blood sugar,2 h postprandial blood glucose,glycosylated hemoglobin,fasting insulin,HOMA-IR one week,one month,3 months,and 6 months after surgery in the two groups were significantly lower than those before surgery (P＜0.05).The fasting blood sugar,and 2 h postprandial blood glucose were lower in Roux-en-Y group than in Billroth Ⅱ group (P＜0.05).The glycosylated hemoglobin in Roux-en-Y group was lower than those in Billroth Ⅱ group at 3 months,and 6 months after surgery (P＜0.05).Compared with those before surgery,GIP and GIP/GLP-1 in the two groups at one week,one month,3 months,and 6 months were significantly decreased after operation (P＜0.05).Also,they were significantly lower in Roux-en-Y group compared with Billroth Ⅱ group at the same time point.Conclusion Roux-en-Y anastomosis after subtotal gastrectomy may be more beneficial?for reducing blood glucose in T2DM patients,which may be more beneficial for keeping the balance of entero-insular axis.
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Objective To explore the feasibility of gastroesophagostomy when patients with esophagus carcinoma com bined with stomach carcinoma.Methods In March 2011 to May 2016,our department completed with the method of genera tion of esophagus stomach in the treatment of esophageal cancer merger 18 cases of gastric cancer patients.Age 52-67,16 ca ses of esophageal lesions located in the middle section,2 cases located in the chest.4 cases were gastric lesions located in the proximal stomach,14 cases were located in the distal stomach Four kinds of surgical methods can be chosen from.Proximal or distal stomach could be used to replace esophagus and the blood supply came from left gastric artery or right gastroepiploic artery.Stomach tissue separation and reverse gastric tube were used if the length of stomach was insufficieut.Results When resection of esophageal and gastric carcinoma were accomplished simultaneously,residue stomach can be used as a replacement of esophagus if patients were rigidly selected.Conclusion Residue stomach was a good substitute after radical resection of esoph agus and gastric dual-source carcinoma.Patients chosen and surgery design were both important.
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Objective To explore the clinical effects of pyloroplasty on proximal gastrectomy in patients with lesions in cardia of the bottom of stomach.Methods One hundred cases of the proximal gastric diseases who were enrolled in the second affiliated hos-pital of Chongqing medical university from the January 2010 to December 2013 were selected in this prospective randomized con-trolled experimental study.Among them,6 cases were excluded,and the other 94 cases were divided into two groups:the experimen-tal group (A),in which 54 patients were underwent additional pyloroplasty surgery;the control group (B),in which 40 patients were underwent with no strings attached pyloroplasty.All patients were followed up.Then,the clinical indicators during hospitaliza-tion,term complications and repeated endoscopy prompted pyloric stenosis and reflux esophagitis situation three months after dis-charged from hospital were observed.Results There was no significant difference in the incidence rate of gastroplegia (P >0.05);there were significant differences in other clinical indicators during the postoperative hospitalization and the incidence rate of compli-cations (P <0.05).Conclusion Proximal gastrectomy additional pyloroplasty could reduce gastric retention,decrease the incidence of reflux esophagitis,shorten the hospital period and could be helpful for recovery,thus it is recommended to be further promoted.
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Objective: to evaluate a barium study of the upper gastrointestinal tract in early postoperative monitoring of bariatric surgery patients, recording the anatomical characteristics of the gastric remnant and the frequency of complications such as leakage of contrast and emptying difficulties. Materials and Methods: we retrospectively evaluated the barium study of the upper gastrointestinal tract performed in 168 patients after gastric bypass (GBP) and 98 patients after vertical subtotal gastrectomy (VSG). All evaluated examinations were performed in the first five days after surgery. Gastric remnant volume was registered in relation to the T12 vertebral body (only in GBP), the presence and site of contrast leakage and gastric remnant emptying difficulties. Results: the average age of patients undergoing GBP was 43 years, and 37 years for VSG. The average volume of gastric remnant of patients with GBP was 1.5 T12 vertebral bodies. Two GBP operated patients (1.2 percent) had leakage of the contrast medium at the level of the gastroenteric anastomosis; in VSG operated patients the contrast leakage occurred in 7 cases (7.1 percent), the most frequent site being the left side cephalic portion of the gastric remnant. All cases with contrast leakage were subsequently studied using computed tomography, finding the presence of wound dehiscence or fluid collections adjacent to the gastric remnant. Emptying difficulty was observed in 12 patients operated for GBP (7.1 percent); there was no record of this complication in patients undergoing VSG. Conclusion: the upper gastrointestinal barium study is useful in patients after bariatric surgery to assess the early postoperative anatomy and volume of the gastric remnant, as well as to detect possible complications. It is a simple test, which should be applied as a routine control in these patients.
Objetivo: evaluar el estudio baritado del tubo digestivo alto en el control postoperatorio precoz de pacientes operados de cirugía bariátrica, registrando las características anatómicas del remanente gástrico y la frecuencia de complicaciones como filtración del medio de contraste y dificultad al vaciamiento. Materiales y método: se evaluó retrospectivamente el estudio baritado del tubo digestivo alto realizado en 168 pacientes postoperados de bypass gástrico (BPG) y 98 pacientes postoperados de gastrectomía subtotal vertical (GSV). Todos los exámenes evaluados fueron realizados en los primeros cinco días postcirugía. Se registró volumen del remanente gástrico en relación al cuerpo vertebral T12 (sólo en BPG), presencia y sitio de filtración del medio de contraste y dificultad al vaciamiento del remanente gástrico. Resultados. La edad promedio de los pacientes sometidos a BPG fue de 43 años y GSV 37 años. El volumen promedio del remanente gástrico de los pacientes con BPG fue 1,5 cuerpos vertebrales T12. Dos pacientes operados de BPG (1,2 por ciento) presentaron filtración de medio de contraste a nivel de la anastomosis gastro-enteral; en los pacientes operados de GSV la filtración del medio de contraste ocurrió en 7 casos (7,1 por ciento), siendo el sitio más frecuente la porción cefálica lateral izquierda del remanente gástrico. Todos los casos de filtración de medio de contraste fueron posteriormente estudiados con tomografía computada, comprobándose la presencia de dehiscencia de la sutura o bien colecciones líquidas adyacentes al remanente gástrico. Se observó dificultad al vaciamiento en 12 pacientes operados de BPG (7,1 por ciento); no se registró esta complicación en los pacientes operados de GSV. Conclusión: el estudio baritado del tubo digestivo alto es útil en pacientes postoperados de cirugía bariátrica para conocer la anatomía y el volumen del remanente gástrico en el postoperatorio precoz, así como también para detectar posibles complicaciones...
Subject(s)
Humans , Male , Female , Pregnancy , Adult , Middle Aged , Barium , Bariatric Surgery/methods , Gastrectomy/methods , Upper Gastrointestinal Tract , Bariatric Surgery/adverse effects , Retrospective Studies , Gastrectomy/adverse effects , Contrast Media , Postoperative PeriodABSTRACT
El paciente obeso es difícil de tratar. La cirugía para la obesidad en pocos meses logra disminuir más del 20 por ciento del peso corporal. Las técnicas quirúrgicas actúan restringiendo la capacidad gástrica y/o produciendo malabsorción parcial de los alimentos. Todas han demostrado ser eficaces para el tratamiento de la obesidad y mejorar sus comorbilidades asociadas, destacando el alto porcentaje de remisión de la diabetes tipo 2, especialmente con las técnicas malabsortivas. El banding gástrico tienen la menor tasa de remisión de diabetes tipo2. La mayoría de los beneficios de la cirugía persisten más de 10 años, lo que ha permitido observar disminución del riesgo de aparición de enfermedades del ámbito metabólico, reducción del riesgo cardiovascular y de la mortalidad general de obesos mórbidos operados. Actualmente, las técnicas quirúrgicas más frecuentes son el bypass gástrico y la gastrectomía vertical (manga gástrica). La cirugía bariátrica tiene baja tasa de morbimortalidad en centros quirúrgicos expertos, sin embargo se pueden producir complicaciones nutricionales que se deben prevenir o tratar precozmente. La participación de un equipo multidisciplinario con expertos en nutrición, salud mental y actividad física aumenta las posibilidades de lograr una mejor reducción y mantención del peso, ya que con todas las técnicas se puede producir reganancia de peso en el largo plazo.
The obese patient is difficult to treat. Obesity surgery in a few months can accomplish more than 20 percent decrease in body weight. The techniques use in bariatric surgery, act through the restriction of gastric capacity or partial food malabsortion. All of them had demonstrated to be effective for obesity treatment and improve related co morbidities, highlighting a high percentage of remission of diabetes mellitus 2, specially in malaabsortion techniques. Gastric banding has the lowest rate of remission of type 2 diabetes. Most of the benefits of surgery, persist for more than 10 years. This characteristic had permitted to observe a decreased risk of metabolic disease, a reduction of cardiovascular risk and obese mortality rate. Currently the most frequent bariatric surgery techniques are gastric bypass and vertical gastrectomy (sleeve gastrectomy). Bariatric surgery has low morbidity and mortality rate in surgical bariatric centers. However nutritional complications may occur, so they should be prevent or early treat. A multidisciplinary team is demanded, with nutrition, mental health and physical activity experts, for an integrated management and follow up. Only with the integral therapy, it can increase the chances of achieving a better reduction and weight maintenance. If this conditions fail, the patient can regain weight, indepent of the type on bariatric surgery.
Subject(s)
Humans , Bariatric Surgery/methods , Obesity/surgery , Postoperative Complications , Comorbidity , /surgeryABSTRACT
PURPOSE: Laparoscopy-assisted distal gastrectomy (LADG) is a widely accepted surgery for early gastric cancer. However, its use in advanced gastric cancer has rarely been studied. The aim of this study is to investigate the feasibility and survival outcomes of LADG for pT2 gastric cancer. MATERIALS AND METHODS: Between January 2004 and December 2009, we evaluated 67 and 52 patients who underwent open distal gastrectomy (ODG) and LADG, respectively, with diagnosis of pT2 gastric cancer. The clinicopathological characteristics, postoperative outcomes, and survival were retrospectively compared between the two groups. RESULTS: There were statistically significant differences in the proximal margin of the clinicopathological parameters. The operation time was significantly longer in LADG than in ODG (207.7 vs. 159.9 minutes). There were 6 (9.0%) and 5 (9.6%) complications in ODG and LADG, respectively. During follow-up periods, tumor recurrence occurred in 7 (10.4%) patients of the ODG and in 4 (7.7%) patients of the LADG group. The 5-year survival rate of ODG and LADG was 88.6% and 91.3% (p=0.613), respectively. In view of lymph node involvement, 5-year survival rates were 96.0% in ODG versus 97.0% in LADG for patients with negative nodal metastasis (p=0.968) and 80.9% in ODG versus 78.7% in LADG for those with positive nodal metastasis (p=0.868). CONCLUSION: Although prospective study is necessary to compare LADG with open gastrectomy for the treatment of advanced gastric cancer, laparoscopy-assisted distal gastrectomy might be considered as an alternative treatment for some pT2 gastric cancer.
Subject(s)
Humans , Diagnosis , Follow-Up Studies , Gastrectomy , Laparoscopy , Lymph Nodes , Neoplasm Metastasis , Prospective Studies , Recurrence , Retrospective Studies , Stomach Neoplasms , Survival RateABSTRACT
Objective To approach effect of Yiqihuoxue decoction on remnant stomach paralysis syndrome after subtotal gastrectomy. Methods A total of 44 patient of remnant stomach paralysis syndrome were randomly recruited into a control group and a treatment group, with 22 patients in each group. The control group was treated with TPN parenteral alimentation. On this basis, the treatment group was treated with Yiqihuoxue decoction and mental intervention. The clinical effects were observed in both groups after the treatment. Results The total effective rate was 54.55% and 100% in the control group and the treatment group respectively, showing statistic difference(P=0.00625 ＜0.01).Conclusion It was effective to treat remnant stomach paralysis syndrome with Yiqihuoxue decoction, TPN parenteral nutrition and mental intervention.
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Splenic artery pseudoaneurysm (SAP) is a very rare case, postoperatively. SAP originates from many causes such as complication of chronic pancreatitis in adults and blunt abdominal trauma in children. SAP related to surgery may result from direct tissue injury during operation. Urgent angiography is helpful in diagnoses and life-saving procedures as the endovascular embolization simultaneously. However, endovascular management is not a definite treatment modality in patients previously operated on because the blood supply of remaining organs will be insufficient after embolization. In this paper, we report a rare case that is proximal splenic artery pseudoaneurysm after radical subtotal gastrectomy in a 63-year-old male patient with early gastric cancer, as well as a brief review.
Subject(s)
Adult , Child , Humans , Male , Middle Aged , Aneurysm, False , Angiography , Gastrectomy , Pancreatitis, Chronic , Splenic Artery , Stomach NeoplasmsABSTRACT
PURPOSE: This aim of this study was to evaluate changes in gastric volume and organ position as a result of delayed gastric emptying after a subtotal gastrectomy performed as part of the treatment of stomach cancer. MATERIALS AND METHODS: The medical records of 32 patients who underwent concurrent chemoradiotherapy after a subtotal gastrectomy from March 2005 to December 2008 were reviewed. Of these, 5 patients that had more than 50 cc of residual gastric food detected at computed tomography (CT) simulation, were retrospectively enrolled in this study. Gastric volume and organ location was measured from CT images obtained before radiotherapy, twice weekly. In addition, authors evaluated the change of radiation dose distribution to planning the target volume and normal organ in a constant radiation therapy plan regardless of gastric volume variation. RESULTS: A variation in the gastric volume was observed during the radiotherapy period (64.2~340.8 cc; mean, 188.2 cc). According to the change in gastric volume, the location of the left kidney was shifted up to 0.7 - 2.2 cm (mean, 1.2 cm) in the z-axis. Under-dose to planning target volume (V43, 79.5+/-10.4%) and over-dose to left kidney (V20, 34.1+/-12.1%; Mean dose, 23.5+/-8.3 Gy) was expected, given that gastric volume change due to delayed gastric emptying wasn't taken into account. CONCLUSION: This study has shown that a great change in gastric volume and left kidney location may occur during the radiation therapy period following a subtotal gastrectomy, as a result of delayed gastric emptying. Detection of patients who experienced delayed gastric emptying and the application of gastric volume variation to radiation therapy planning will be very important.
Subject(s)
Humans , Chemoradiotherapy , Gastrectomy , Gastric Emptying , Kidney , Medical Records , Retrospective Studies , Stomach NeoplasmsABSTRACT
A patient who had previously undergone a subtotal gastrectomy was scheduled for removal of a brain tumor under general anesthesia. Anesthesia was induced with lidocaine and propofol with rocuronium for neuromuscular blockade. She had fasted for 10 hours, but after mask ventilation, she aspirated gastric juice and materials. The oral cavity was suctioned promptly and the trachea was intubated. Intraoperative high FiO2 and dopamine were administrated to maintain the oxygen saturation and blood pressure. She received postoperative ventilatory care in the intensive care unit for 2 weeks. An upper gastrointestinal series and fiber endoscopy were performed but she had no obstruction and reflux esophagitis except delayed passage of the contrast media. She had no risk factors for pulmonary aspiration. As in this case, patients with previous gastrointestinal surgery should be considered preoperative workup for GI motility or pathology, and adequate premedication.
Subject(s)
Humans , Androstanols , Anesthesia , Anesthesia, General , Blood Pressure , Brain Neoplasms , Contrast Media , Dopamine , Endoscopy , Esophagitis, Peptic , Gastrectomy , Gastric Juice , Intensive Care Units , Lidocaine , Masks , Mouth , Neuromuscular Blockade , Oxygen , Pneumonia , Premedication , Propofol , Risk Factors , Suction , Trachea , VentilationABSTRACT
BACKGROUND/AIMS: The aims of this study were to evaluate the incidence of reflux esophagitis in patients after a subtotal gastrectomy and to determine risk factors for reflux esophagitis. METHODS: Among 225 patients who underwent a subtotal gastrectomy from June 2003 to December 2004 at Seoul National University Bundang Hospital, 201 patients who received follow-up for more than six months and underwent at least one endoscpoic examination were retrospectively reviewed. We used the Los Angeles (LA) classification system and included a minimal change for reflux esophagitis. RESULTS: There were 173 patients who underwent a Billroth I procedure and 28 patients who underwent a Billroth II procedure. The cumulative incidence of reflux esophagitis was 40.8%. A patient age > or =65 years (p=0.04), a follow-up duration > or =40 months (p=0.03), bile reflux gastritis (p or =4 (p=0.012), bile reflux gastritis (p=0.002) and postoperative obesity (p=0.038) were risk factors for a minimal change. A patient age > or =65 years (p=0.04), a follow-up duration > or =40 months (p=0.03) and Helicobacter pylori eradication before surgery (p<0.01) were independent risk factors for LA grade A/B reflux esophagitis. CONCLUSIONS: Bile reflux gastritis is a risk factor for the development of reflux esophagitis after a subtotal gastrectomy. Preoperative helicobacter eradication is also associated with reflux esophagitis, except for a minimal change, but further studies are needed.
Subject(s)
Humans , Bile Reflux , Esophagitis, Peptic , Follow-Up Studies , Gastrectomy , Gastritis , Gastroenterostomy , Helicobacter , Helicobacter pylori , Incidence , Los Angeles , Obesity , Retrospective Studies , Risk FactorsABSTRACT
Objective To observe clinical effect of treating gastropareds after subtotal gastrectomy with integrated traditional Chinese and western medicine.Methods 98 cases patients with gastroparesis after subtotal gastrectomy were randomly divided into a treatment group and a control group.The control group was treated with western medicine,and the treatment group was treated with modified Liumo decoction in addition to western medicine.A six months'follow-up was performed after the treatment to observe clinical effect.Results The therapeutic effect in the treatment group was significantly better than the control group,with P＜0.05.Conclusion Integrated traditional Chinese and western medicine therapy has better effect in treating gastroparesis after subtotal gastrectomy than exclusive western medicine therapy.
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Usually in the subtotal gastrectomy, the left and the right gastric arteries, as well as the left and the right gastroepiploic arteries are ligated. Thus, to avoid a blue stomach surgeons preserve the spleen and the short gastric arteries. When a radical subtotal gastrectomy with splenectomy is performed, meticulous caution is necessary; otherwise, the subtotal gastrectomy might have to be changed to a total gastrectomy to prevent a blue stomach. We report the case of a 67-year-old woman who had distal stomach cancer with a splenic solitary mass, for which splenic meatastasis could be excluded. We planned and performed a laparoscopy-assisted radical subtotal gastrectomy with splenectomy as the diagnostic and therapeutic option. In this case, to avoid a remnant stomach infarction or total gastrectomy we saved the left gastric artery and vein with clearing perivascular soft tissue, lymphatics, and lymph nodes. Thus the radical therapeutic goal was reached, and serious complications were avoided.
Subject(s)
Aged , Female , Humans , Arteries , Gastrectomy , Gastric Stump , Gastroepiploic Artery , Infarction , Lymph Nodes , Spleen , Splenectomy , Stomach Neoplasms , Stomach , VeinsABSTRACT
PURPOSE: The five-year survival rate is over 95% for radically resected early gastric cancer. The development of diagnostic techniques enables early detection of gastric cancer, so the life expectancy of patients with early gastric cancer is prolonged. Therefore, a limited number of surgeries are performed these days for the purpose of increasing the quality of life. The purpose of this study is to assess the postoperative quality of life after a pylorus-preserving gastrectomy (PPG) compared with that after a subtotal gastrectomy with gastroduodenal anastomosis (B-I). MATERIALS AND METHODS: One hundred seven (107) patients who underwent gastric surgery for early gastric cancer from January 1999 to December 2003 at the Department of Surgery of Chonnam National University Hospital were selected. We compared patients who underwent a PPG with those who underwent a B-I. The clinical results were compared by using the chi-square test and the Student's T-test. The data were considered to be significant when the P value was less than 0.05. RESULTS: Twenty-nine patients (29) underwent a PPG, and the other seventy-eight (78) patients underwent a B-I. There was no significant difference between the two groups on sex, age, and postoperative abdominal symptoms. The patients who underwent a PPG showed shorter operation times and less reflux gastritis and esophagitis on endoscopic evaluation than the patients who underwent a B-I. CONCLUSION: The pylorus-preserving gastrectomy (PPG) is a more physiologic operation than the subtotal gastrectomy with gastroduodenal anastomosis (B-I) and improves the postoperative quality of life.