Current status of the treatment of common bile duct stones after Billroth Ⅱ subtotal gastrectomy / 临床肝胆病杂志

Common bile duct stones are a common of digestive system disease, and as one of the long-term complications after Billroth II subtotal gastrectomy, it has attracted more and more attention from clinicians. Common bile duct stones after Billroth II subtotal gastrectomy have a complex pathogenesis, including neurological, humoral, and mechanical factors. Even though there are many methods to remove stones, there are still controversies over the selection of digestive endoscopy, surgical operation, or percutaneous transhepatic approach. Clinicians should fully evaluate the specific conditions of patients and formulate individualized treatment regimens to achieve the best treatment outcome.

Progress of risk factors of gastroparesis syndrome after radical distal gastrectomy / 肿瘤研究与临床

Postsurgical gastroparesis syndrome (PGS), as a kind of very serious complication, usually followed radical distal gastrectomy due to gastric cancer. The occurrence of PGS affects the patients' postoperative recovery. The pathogenesis of PGS is still unknown throughly at present. According to the current researches,it is considered as a kind of functional delayed gastric emptying caused by a series factors. This paper reviews the progress of risk factors for PGS,with a view to providing clinical guidance.

Clinical effect of Chinese and western medicine in the treatment of gastric emptying disorder after gastric cancer surgery / 中国基层医药

Objective To observe the curative effect of traditional Chinese and western medicine in the treatment of functional delayed gastric emptying after major gastrectomy.Methods From March 2010 to March 2015, a total of 128 cases with gastric dissection of functional delayed gastric emptying after major gastrectomy in the Affiliated Hospital of Chengdu University of TCM were divided into control group ( n＝64) and observation group ( n ＝64) based on a random number table.The control group was given western medicine,the observation group was given traditional Chinese medicine combined with Western medicine.The clinical efficacy,gastric function recovery time of the two groups were compared.Results The gastric function recovery time in the observation group was (14.12 ±1.36)d, which was significantly shorter than (20.56 ±2.10)d in the control group,and the difference was statistically significant (P＜0.05).The total effective rate of the observation group (87.50%) was significantly higher than that of the control group (68.75%),and the difference was statistically significant ( P＜0.05).Conclusion Comprehensive therapy combined with western and Chinese medicine in the treatment of functional delayed gastric emptying after major gastrectomy has significant clinical effect ,which is worthy of further application.

Nursing Intervention for a Delayed Gastric Emptying after Pylorus-preserving Gastrectomy for Early Gastric Cancer

PURPOSE: The purpose of this case report is to describe the surgical procedure of pylorus preserving gastrectomy and treatment methods, and the nursing process for postoperative complications namely delayed gastric emptying. METHODS: This case study describes the treatment methods and nursing process for a patient who visited the emergency room because of delayed gastric emptying after a pylorus preserving gastrectomy. RESULTS: The symptoms of this patient were resolved by botox-injection, none per oral, total parenteral nutrition, nutrition education after diagnosis by using abdominal x-ray, gastric emptying study, upper gastrointestinal series, and esophagogastroduodenoscopy. CONCLUSION: According to the result of this case study, nurses should be informed about delayed gastric emptying and how to apply the correct nursing process to the patient.

Post-Gastrectomy Osteomalacia mimicking rheumatologic disorders: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#Osteomalacia is one of the post-gastrectomy complications resulting from the impaired absorption of vitamin D and calcium.1 Vitamin D deficiency or osteomalacia can be diagnosed by clinical, biochemical and radiographic parameters, and bone biopsy. The radiologic findings of “Looser zones” or pseudofractures aid in the diagnosis. Severe generalized pain, mimicking rheumatologic disorders is one of the features that maybe a presenting complaint of osteomalacia. We report a case of osteomalacia as a consequence of gastric by-pass surgery.

ASSESSMENT OF THE GASTRO-JEJUNO-DUODENAL TRANSIT AFTER JEJUNAL POUCH INTERPOSITION / AVALIAÇÃO DO TRÂNSITO GASTROJEJUNODUODENAL APÓS INTERPOSIÇÃO DE ALÇA JEJUNAL

Background : The jejunal pouch interposition between the gastric body and the duodenum after the gastrectomy, although not frequent in the surgical practice today, has been successfully employed for the prevention and treatment of the postgastrectomy syndromes. In the latter, it is included the dumping syndrome, which affects 13-58% of the patients who undergo gastrectomy. Aim : Retrospective assessment of the results of this procedure for the prevention of the dumping syndrome. Methods : Fourty patients were selected and treatetd surgically for peptic ulcer, between 1965 and 1970. Of these, 29 underwent vagotomy, antrectomy, gastrojejunalduodenostomy at the lesser curvature level, and the 11 remaining were submitted to vagotomy, antrectomy, gastrojejunal-duodenostomy at the greater curvature level. The gastro-jejuno-duodenal transit was assessed in the immediate or late postoperative with the contrasted study of the esophagus, stomach and duodenum. The clinical evolution was assessed according to the Visick grade. Results : Of the 40 patients, 28 were followed with the contrast evaluation in the late postoperative. Among those who were followed until the first month (n=22), 20 (90%) had slow gastro-jejuno-duodenal transit and in two (10%) the transit was normal. Among those who were followed after the first month (n=16), three (19%) and 13 (81%) had slow and normal gastric emptying, respectively. None had the contrasted exam compatible with the dumping syndrome. Among the 40 patients, 22 underwent postoperative clinical evaluation. Of these, 19 (86,5%) had excellent and good results (Visick 1 and 2, respectively). Conclusions : The jejunal pouch interposition showed to be a very effective surgical procedure for the prevention of the dumping syndrome in gastrectomized patients.

Racional : A interposição de alça jejunal entre o corpo gástrico e o duodeno após a antrectomia, apesar de pouco frequente na prática cirúrgica atual, tem sido empregada com sucesso na prevenção e tratamento das síndromes pós-gastrectomias. Entre estas se inclui a síndrome de dumping, que acomete 13-58% dos pacientes gastrectomizados. Objetivo : Avaliação retrospectiva dos resultados desse procedimento na prevenção da síndrome de dumping. Métodos : Foram selecionados 40 pacientes todos encaminhados para tratamento cirúrgico de úlcera cloridropéptica entre 1965 e 1970. Destes, 29 foram submetidos à vagotomia, antrectomia, gastrojejunoduodenostomia no nível da pequena curvatura, e os 11 restantes à vagotomia, antrectomia, gastrojejunoduodenostomia no nível da grande curvatura. O trânsito gastrojejunoduodenal foi avaliado no pós-operatório imediato ou tardio por meio do estudo contrastado de esôfago, estômago e duodeno. A evolução clínica no pós-operatório foi avaliada segundo a classificação de Visick. Resultados : Dos 40 pacientes, 28 foram acompanhados com o estudo contrastado no pós-operatório tardio. Entre aqueles de até o 1º mês de pós-operatório (n=22), 20 (90%) apresentaram o trânsito gastrojejunoduodenal lento e dois (10%) tiveram o trânsito normal. Entre os que puderam ser acompanhados após o 1º mês (n=16), três (19%) e 13 (81%) mostraram o esvaziamento gástrico lento e normal, respectivamente. Nenhum apresentou o estudo contrastado compatível com a síndrome de dumping. Entre os 40 doentes, 22 foram submetidos à avaliação clínica pós-operatória. Destes, 19 (86,5%) apresentaram excelentes e bons resultados (Visick 1 e 2, respectivamente). Conclusões : A interposição de alça jejunal mostrou-se procedimento cirúrgico bastante eficaz na prevenção da síndrome de dumping em pacientes gastrectomizados.

Prevention and treatment of delayed gastric emptying after operation for esophageal carcinoma / 中国基层医药

Objective To investigate the cause,treatment and prevention of delayed gastric emptying (DGE) after operation for esophageal carcinoma.Methods The clinical data of 13 cases with DGE after operation for esophageal carcinoma were analyzed retrospectively.Results DGE occurred at 10th day after operation.10 cases with functional delayed gastric emptying(FDGE) recovered after conservative treatmeut.3 cases with mechanical delayed gastric emptying(MDGE) were given surgical treatment.Conclusions The anatomical displacement of stomach may be the main cause of DGE.DGE is also related to vagus nerve and postoperative inadequate gastrointestinal decompression.Clinical symptoms,X-ray barium meal radiography and gastroscopy examination are the important diagnostic method.Conservative treatment should be the first choice for FDGE.The use of some gastro-intestinal prokinetic drugs may have a beneficial effect on FDGE.Once the diagnosis of MDGE is established,surgical treatment should be performed as early as possible.The fully preoperative preparation,the precise and concise techniques in operation and postoperative appropriate management may decrease the occurrence of DGE.

Nutritional treatment after gastrectomy

Nutrition plays a major role in cancer development and treatment. Malnutrition is a significant and common problem in cancer patients and has been recognized as an important component of adverse outcomes, including increased morbidity and mortality. At the time of diagnosis, the majority of patients with upper gastrointestinal cancer, including those having undergone gastrectomy, have already suffered from significant nutritional deficiencies. Therefore, optimization of nutritional status can help cancer patients maintain the body's nutrition stores and improve symptoms such as anemia and neuropathy that may be associated with nutritional deficiencies. Depending on the etiology of symptoms, iron or Vitamin B12 (injection or oral) may be given. Early recognition and detection of risk for malnutrition may be performed using nutrition screening followed by comprehensive assessments. The most effective approach to malnutrition and nutritional deficiency is the prevention of its initiation through nutrition monitoring and intervention.

Diagnosis and treatment of functional delayed gastric emptying after subtotal gastrectomy:a report of 15 cases / 中国基层医药

Objective To explore the etiology,pathogenesis,diagnosis and treatment of functional evacuation disorder in gastric stump after subtotal gastrectomy. Methods 15 cases with functional evacuation disorder after sub-total gastrectomy were analyzed retrospectively. Results All 15 cases were recovered by conservational therapy. Con-dusion Functional delayed gastric emptying after subtotal gastrectomy is a functional disease and can be healed with comprehensive conservation therapy at all.

Brown Bowel Syndrome that Developed after Total Gastrectomy: A Case Report

The brown bowel syndrome (BBS) is an uncommon disorder, which is characterized by brown pigmentation of the intestine due to the accumulation of lipofuscin in the smooth muscle cells. Vitamin E deficiency has generally been considered as the cause of this malady. BBS has been reported in a wide variety of malabsorptive diseases involving the pancreas, liver and gastrointestinal tract. We report here on a case of brown bowel syndrome that occurred in a 73-year-old man who had undergone total gastrectomy 11 years ago for gastric adenocarcinoma. He has complained about intestinal obstructive symptoms for several years, and these symptoms were recently aggravated. He showed a low serum concentration of total protein, albumin and cholesterol, and he had been treated for megaloblastic anemia due to vitamin B12 and folate deficiency several months ago. The resected small bowel showed lipofuscin deposition in the muscle layer of the intestine and large vessels. The electron microscopic examination revealed multiple electron dense lipofuscin deposits with irregular shapes and sizes in the cytoplasm.

Resultados del tratamiento quirúrgico del cáncer gástrico: Análisis de 423 casos / Surgical treatment of gastric cancer: results in 423 cases

Background: Gastric cancer is the second cause of cancer death worldwide and the first cause in Chile. Management of this pathology is controversial. Aim: To report the results on morbidity, mortality, and long-term survival rates of surgical treatment of gastric cancer, and compare them with those reported in the literature. Material and Methods: Follow up of 423 patients (aged 16 to 88 years, 271 males) operated for a gastric adenocarcinoma between 1996 and 2002. Patients were staged with the 5th edition of TNM staging system, and the 2nd edition in English of the Japanese Classification of Gastric Cancer. Morbidity was assessed using the classification of the Memorial Kettering Cancer Center group. Kapplan-Meier method was used to assay survival, and Log rank Test to compare long-term survivals. Results: Resectability of the lesions was 70.4 percent, and 88 percent of them corresponded to a curative-intended surgery. Seventy percent of patients were in stage TNM IIIA or higher at the moment of surgery. Mortality in curative intended operated patients was 4.2 percent, and morbidity was 33.7 percent. Overall five years survival rate was 33 percent: In the group with curative intended surgery it was 52 percent. Two years survival rate in the non intended curative group was 3.4 percent. Conclusions: The reported incidence of complications in our series is similar to that reported in the literature. Five year survival rates, morbidity and mortality were comparable to those reported abroad

A Case of an Anorectic Post-gastrectomy Patient Treated with Kososan and Rikkunshito / 日本東洋医学雑誌

We report a case of an anorectic 71-year-old male post-gastrectomy patient who was successfully treated with Koso-san and Rikkunshi-to. The patient underwent resection for early gastric cancer (0-IIa+IIc). After partial gastrectomy, he suffered from nausea and vomiting. He was treated with endoscopic balloon dilatation at the anastomotic site, and was simultaneously treated with some western drugs. However, he was completely unable to eat because of nausea and vomiting. Oriental medicine was then recommended. We treated him with Kampo medicines in combination with parenteral nutrition. After the administration of Koso-san, his nausea and vomiting disappeared immediately and he could ingest a fluid diet. Further, after the administration of Koso-san and Rikkunshi-to, his food intake increased. Finally, he could eat ordinary meals and his food intake reached an adequate level. This suggests that Koso-san and Rikkunshi-to are useful in the treatment of anorectic patients after gastrectomy.

Duodenojejunostomia látero-lateral: uma alternativa cirúrgica para o tratamento do "dumping" pós gastrectomia / Side to side duodenojejunostomy: a surgical alternative for dumping after gastrectomy

Most patients with partiaI gastrectomy have no postoperative problems. Some of them, however, develop severe nutritional disturbance, particularly those with Bilroth II reconstruction, which can be treated clinically in the majority of the cases. Those with important mal absorptive problems require surgery. In this article we present a technical alternative for those patients who need reintervention over a BII operation. Our technique has the advantage of not touching the duodenum previously sutured.

Small Intestinal Perception in Patients with Gastrectomy / 대한소화관운동학회지

BACKGROUND/AIMS: After gastrectomy, patients often experience various gastrointestinal symptoms due to the rapid emptying of ingested food into the small intestine. Symptoms of the postgastrectomy syndrome, however, decrease as time passes. The aim of this study is to evaluate the role of sensory function of the small intestine in postgastrectomy patients. METHODS: Liquid meal loading test and balloon distension stimuli test were carried out in 39 postgastrectomy patients and 32 healthy controls. The polyethylene balloon was advanced to intestine, 10 cm apart from anastomosis in patients and 3rd portion of duodenum in controls. Sensory function was assessed by scoring perception for nausea, fullness, and abdominal discomfort or pain during random-order stimulus of 20, 40, and 60 ml of balloon inflation. RESULTS: The maximum tolerable volume of liquid meal intake for postgastrectomy patients was significantly less than that of the controls (p<0.05). Twelve of the 26 patients, who ingested less than normal range, had symptoms of the postgastrectomy syndrome. Total sensation scores after balloon distension stimuli were significantly lower than those of the controls. The type of gastrectomy and the postsurgical duration did not affect the maximum tolerable volume of liquid meal and total sensation scores after balloon distension stimuli. CONCLUSIONS: In comparison to healthy controls, postgastrectomy patients showed an obviously lower maximum tolerable volume of liquid meal, in addition to being significantly less perceptive of small intestine to distension stimuli. This decrease of small intestinal perception is deduced to be part of the adaptation to rapid emptying of ingested food into the small intestine in such patients.

Effects of Hochu-ekki-to for Bone Disorder of Gastrectomized Patients / 日本東洋医学雑誌

Fifty years has passed since Sarasin described a case of osteomalacia.<br>We studied the efficacy of Hochu-ekki-to compared with a regimen of activated vitamin D and lactate calcium. The efficacy was confirmed by administration of the drug to 6 patients with bone disorder after gastrectomy.<br>MD/MS (microdensitometry/multiple scanning) examinations demonstrated the efficacy of the drug with improvement of three indices of bone mineral content.

Hydrogen Breathing Test in Post-gastrectomized Patients / 第三军医大学学报

Hydrogen level in the exhaling air after oral lactose or glucose loading was determined in normal subjects and patients after gastreetoaiy. Basal hydrogen was less than 30 ppm in all the 16 normal subjects. After lactose ingestion, 13 subjects out of the 16 (81.2%) showed an increass of hydrogen excretion of 20 ppm or more. The average peak time of hydrogen accretion was in the 3.25 hours after lactose ingestion. After glucose ingestion,the increase of hydrogen excretion was less than 20 ppm. In 7 patients with Billroth I gastrec- tomy and 14 patients with Billroth II gastrectomy, increase of hydrogen excretion after lactose ingestion occurred in 6 out of the 7 (85.7%) and 12 out of the 14 (85.7%) respectively, which is not significantly different from that of the control. After glucose intake, increase of hydrogen excretion occurred in 1 out of the 7 (14.2%) and 5 out of the 14 (35.7%). The elevation of hydrogen in the exhaling air indicates the overgrowth of bowel bacteria. Our findings suggest that hydrogen breathing test after lactose loading is insensitive to reveal this phenomenon in patients after gastrectomy, but after glucose loading, the test might carry out this function especilly in those with Billroth II operation.