Effects of gastrectomy on quality of life of patients with gastric cancer and its evaluation methods / 中华胃肠外科杂志

Surgery is the main curative treatment for gastric cancer. As surgical techniques continue to improve, the scope of radical resection and lymph node dissection has formed consensus and guidelines, so people's attention has gradually shifted to the quality of life (QOL) of patients after surgery. Postgastrectomy syndrome is a series of symptoms and signs caused by complications after gastrectomy, which can affect the quality of life of patients with gastric cancer after surgery. Gastrectomy and anastomosis are closely related to postgastrectomy syndrome. The selection of appropriate surgical methods is very important to the quality of life of patients after surgery. This article reviews the effects of gastrectomy procedures on postoperative quality of life of patients with gastric cancer and its evaluation methods.

Cirugía de revisión post sleeve gástrico en el Sistema Da Vinci / Revised post-sleeve gastric surgery using the Da Vinci System

Introducción. La manga gástrica laparoscópica (SG) se ha establecido como el procedimiento bariátrico más común realizado debido a su efectividad para la pérdida de peso y la resolución de otras comorbilidades relacionadas con la obesidad. Todas sus ventajas deben ser preservadas a través del correcto manejo de sus complicaciones más comunes como el reflujo gastroesofágico (ERGE). Objetivo. Reportar los resultados de la conversión de SG a bypass gástrico (RYGB) para el control de ERGE postoperatorio. Material y Métodos. Se analizó retrospectivamente los datos de todos los pacientes que se sometieron a la cirugía de conversión de SG a RYBG a través del sistema Da Vinci como indicación para el manejo de ERGE, en el periodo de mayo de 2016 a marzo de 2018 en el Hospital de Especialidades Carlos Andrade Marín (Quito, Ecuador) y para ello se recurrió al sistema informático MIS/AS400 y a controles multimodales postquirúrgicos. Resultados. De los 243 pacientes sometidos a gastrectomía vertical, 35 (14.4%) presentaron complicaciones tardías de reflujo gastroesofágico. Esta serie incluyó 22 (62,9%) mujeres y 13 (37,1%) hombres. Trece (37,1%) pacientes tuvieron esofagitis grado B, 17 (48,6%) grado C y 5 (14,3%) grado D. Un total de 17 (6,9%) pacientes necesitaron cirugía de conversión y su evolución fue seguida durante tres meses; no hubo complicaciones ni mortalidad y todos experimentaron remisión del ERGE. Conclusiones. La conversión laparoscópica de SG a RYGB es un procedimiento efectivo para el control y manejo postoperatorio de ERGE. Parece ser una alternativa segura para el tratamiento de ERGE y la mejora de otras comorbilidades asociadas. Es evidente que las indicaciones por las que estos procedimientos son iniciados son cruciales para evitar riesgos quirúrgicos innecesarios y obtener buenos resultados.

Introduction. Laparoscopic sleeve gastrectomy (SG) is the most commonly performed bariatric procedure. We analyzed obesity-related comorbidities, such as GERD, based on the amount of weight loss achieved. Objective. We discuss the outcome of laparoscopic conversion from SG to Roux-en-Y-gastric bypass after GERD onset. Material and Methods. Data from all patients who underwent laparoscopic conversion from SG to RYGB for GERD management between May-March 2018 were retrospectively analyzed at Carlos Andrade Marin Specialties Hospital (Quito, Ecuador) via the MIS/AS400 system and multimodal post-surgical controls. Results. Of 243 patients who underwent SG, 35 (14,4%) had postoperative GERD complications and only 17 (6,9%) qualified for laparoscopic conversion; the series included 22 (62,9%) females and 13 (37.1%) males. A total of 13 (37,1%) patients had grade B esophagitis, 17 (48,6%) grade C and 5 (14,3%) grade D. The remission rate for GERD was 100 %. Postoperative complication rate was 0 %, and mean length of follow-up was three months after conversion. No patients died in this series. Conclusions. Laparoscopic conversion of SG to RYGB is an effective procedure for management of postoperative GERD. It is a safe alternative for treating GERD and improving other comorbidities. It is evident that the indications by which these procedures are initiated are crucial to avoid unnecessary surgical risks and obtain good outcomes.

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.

Choice of bariatric and metabolic surgical procedures / 中华胃肠外科杂志

Bariatric and metabolic surgery has become the clinical hot topic of the treatment of metabolic syndromes including obesity and diabetes mellitus, but how to choose the appropriate surgical procedure remains the difficult problem in clinical practice. Clinical guidelines of American Society for Metabolic and Bariatric Surgery(ASMBS)(version 2013) introduced the procedures of bariatric and metabolic surgery mainly including biliopancreatic diversion with duodenal switch(BPD-DS), laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy(LSG). To choose the appropriate bariatric and metabolic procedure, the surgeons should firstly understand the indications and the contraindications of each procedure. Procedure choice should also consider personal condition (body mass index, comorbidities and severity of diabetes), family and socioeconomic status (postoperative follow-up attendance, understanding of potential surgical risk of gastrectomy and patient's will), family and disease history (patients with high risk of gastric cancer should avoid LRYGB; patients with gastroesophageal reflux disease should avoid LSG) and associated personal factors of surgeons. With the practice of bariatric and metabolic surgery, the defects, especially long-term complications, of different procedures were found. For example, LRYGB resulted in higher incidence of postoperative anemia and marginal ulcer, high risk of gastric cancer as well as the requirement of vitamin supplementation and regular follow-up. Though LSG has lower surgical risk, its efficacy of diabetes mellitus remission and long-term weight loss are inferior to the LRYGB. These results pose challenges to the surgeons to balance the benefits and risks of the bariatric procedures. A lot of factors can affect the choice of bariatric and metabolic procedure. Surgeons should choose the procedure according to patient's condition with the consideration of the choice of patients. The bariatric and metabolic surgery not only manages the diabetes mellitus and weight loss, but also results in the reconstruction of gastrointestinal tract and side effect. Postoperative surgical complications and nutritional deficiency should also be considered. Thereby, individualized bariatric procedure with the full consideration of each related factors is the ultimate objective of bariatric and metabolic surgery.

Gastropatía reactiva: Frecuencia en biopsias endoscópicas evaluadas en la Universidad Nacional de Colombia / Reactive gastropathy: Frequency in endoscopic biopsies evaluated at the Universidad Nacional de Colombia

La gastropatía reactiva (GR) es producida principalmente por antiinflamatorios no esteroideos (AINEs) y reflujo biliar; puede presentarse aisladamente o coexistir con otros tipos de gastritis crónica (GC). Se revisaron 5.079 informes de estudios histopatológicos de biopsias gástricas de 4.254 pacientes, 825 en seguimiento con 2 a 7 estudios. La GR correspondió a 12,8% de los diagnósticos, las GC no atrófica (GCNA) y atrófica multifocal (GCAMF) correspondieron a 63,4% y 27,3% respectivamente. La infección por Helicobacter pylori se presentó en 61,6% de casos con GCNA, 51,5% con GCAMF, 18,5% con GR (p < 0.0001); en casos con coexistencia de GR+GCNA fue 43,9% y de 40,7% para GCAMF+GR. En pacientes en seguimiento aumentaron los diagnósticos de GR: 2 estudios con 22,2%, 3 estudios con 26,7% y 4-7 estudios con 28,8%; los hallazgos histológicos de GR en estos casos posiblemente son residuales, luego de la desaparición de los infiltrados inflamatorios por el tratamiento.

Reactive gastropathy (RG) is primarily produced by non-steroid antiinflammatory drugs (NSAIDs) and bile reflux. It can occur alone or coexist with other types of chronic gastritis (CG). 5,079 histopathological reports of gastric biopsies from 4,254 patients were reviewed: 825 of them had 2 to 7 follow-up studies. 12.8% of these patients were diagnosed with GR while 63.4% were diagnosed with chronic non-atrophic gastritis (CNAG) and 27.3% were diagnosed with chronic multifocal atrophic gastritis (CMAG). Helicobacter pylori infections were found in 61.6% of the cases with CNAG, 51.5% with CMAG, and in 18.5% of cases with GR only (p <0.0001). Among patients suffering from both RG and CNAG 43.9% had H. pylori infections. 40.7% of those suffering from both CMAG and RG were infected with H. pylori. During monitoring of patients RG diagnoses increased to 22.2% in the second study, 26.7% in the third study, and 28.8% in the fourth through seventh studies. Histological findings of RG in these cases are probably residual following disappearance of inflammatory infiltrates due to treatment.

Litiasis vesícular post-gastrectomía radical por adenocarcinoma gástrico en el Instituto Nacional de Enfermedades Neoplásicas, enero 1990 a diciembre del 2000 / Gallstone disease post-radical gastrectomy for gastric adenocarcinoma at the National Institute of Neoplastic Diseases, January 1990 to December 2000

OBJETIVO: Determinar la frecuencia de litiasis vesicular en pacientes post-operados con gastrectomía por adenocarcinoma gástrico, determinar el tiempo de aparición de litiasis vesicular en pacientes gastrectomizados por Adenocarcinoma Gástrico. MÉTODOS: Se realizo un estudio observacional, descriptivo retrospectivo. Se revisó un total de 148 historias clínicas de pacientes sometidos a gastrectomía por adenocarcinoma gástrico en el Instituto Nacional de Enfermedades Neoplásicas en el periodo de 1990 al 2000. RESULTADOS: De los 148 casos de pacientes post gastrectomizados por adenocarcinoma gástrico que fueron enrolados, 29(19.6 por ciento) presentaron litiasis vesicular versus 119(80.9 por ciento) que no presentaron litiasis vesicular como complicación post gastrectomía. La media de edad de 29 pacientes con litiasis vesicular post gastrectomía por adenocarcinoma gástrico fue de 59.9años (min. 39años máx.74años). La distribución de la litiasis vesicular en relación al sexo fue, femenino 18(62.1 por ciento) casos y masculino 11(37.9 por ciento) casos. La media del tiempo de aparición de la litiasis vesicular post gastrectomía fue de 3.1 años, para el sexo masculino 2.7años y para el sexo femenino de 3.3 años. Según el tipo de cirugía se presento litiasis vesicular en 14 pacientes que fueron sometidos a Gastrectomía Subtotal Distal y a 15 pacientes a los que se les practicó Gastrectomía Total. CONCLUSIONES: la Frecuencia de litiasis vesicular post gastrectomía fue de 19.6 por ciento. El periodo de aparición de colelitiasis fue de 3.1 años. La colecistectomía podría ser una toma de decisión importante en pacientes con alto riesgo de litiasis y cáncer vesicular post gastrectomía. El presente trabajo de investigación invita a realizar otros estudios de tipo cohorte en el cual se determine el factor de riesgo principal para la aparición de esta complicación.

SUBJECT: To determinate the frecuency and the time of development of the gallbladder stones in gastrectomy post-operated patients with stomach adenocarcinoma at The National Cancer Institute in Lima, Peru. METHODS: In an observational, descriptive and retrospective case series design, 148 patiens' files who underwent gastrectomy for stomach adenocarcinoma in the National Cancer Institue of Lima during 1990 and 2000, have been reviewed looking for the development of gallbladder stones. RESULTS: A total de 148 patients were involved in this study. 29 of them (19.6 percent) develop gallbladder stones during the (x years of) follow up vs 119(80.9 percent). The mean age ot the 29 patients with gallbladder stones were 59.9 years ans 18 of them were female and 11 male./The mean time of develop gallbladder stones was 3.1 years. According to the type of surgery, 14 patient wiht gallbladder stones underwent to subtotal gastrectomy and 15 to total gastrectomy. CONCLUSIONS The frecuency of gallbladder stones post gastrectomy in this study was 19.6 percent. The mean time of the develop and diagnosis of litiasis was 3.1 years. To perform the colecistectomy at the same time of the gastrectomy could be an important decision in patients with high risk of gallstones and gallbladder cancer. We need furthermore studies to have conclusions about the risk factors.

¿Contribuye la nutrición enteral precoz a disminuir las complicaciones de la gastrectomía radical por cáncer gástrico? / Does contribute early enteral nutrition to decrease the complications of radical gastrectomy for gastric cancer?

OBJETIVO: Evaluar si la administración de nutrición enteral precoz en el post operatorio de los pacientes gastrectomizados por cáncer gástrico contribuye a disminuir la frecuencia de complicaciones post operatorias. MATERIALES Y MÉTODOS: Se realizó un estudio de casos y controles con 120 pacientes, 60 con complicaciones post-operatorias (casos) y 60 pacientes sin complicaciones postoperatorias (controles), pareados por edad y sexo. RESULTADOS: El análisis univariado, encontró que albúmina (p=0.03), hematocrito (p=0.004), nutrición enteral precoz (p<0.01), estadío del cáncer gástrico (p=0.013) se comportaron como variables asociadas al desarrollo de complicaciones post-operatorias; sin embargo, en el análisis múltivariado, sólo la nutrición enteral precoz (p=0.014), nivel de hematocrito (0.019) y estadio anatomopatológico (0.013) mostraron asociación estadística significativa. CONCLUSIONES: La nutrición enteral precoz administrada por sonda nasoenteral en el post-operatorio inmediato, junto con el nivel de hematocrito y estadio anátomo-patológico de la enfermedad, se asociaron estadísticamente a la disminución de las complicaciones postoperatorias, en pacientes sometidos a cirugía radical, por cáncer gástrico.

OBJECTIVE: To evaluate whether the administration of early enteral nutrition in postoperative gastrectomized patients due gastric cancer helps to reduce the frequency of postoperative complications. MATERIALS AND METHODS: A case-control study with 120 patients, 60 with postoperative complications (cases) and 60 patients without post operative complications (controls) matched for age and sex. RESULTS: The uni-variable analysis found that albumin (p=0.03), hematocrit (p=0.004), early enteral nutrition (p<0.01), stage of gastric cancer (p=0.013), behaved as variables associated with the development of postoperative complications. However, in this multivariable analysis, only early enteral nutrition (p=0.014), hematocrit (0.019) and pathological stage (0.013), showed statistically significant association. CONCLUSIONS: The early enteral nutrition administered by nasoenteral tube in the immediate postoperative period, with the hematocrit level and the anatomopathological disease stage is associated with statistically decreased postoperative complications in patients undergoing radical surgery for gastric cancer.

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.

A Comparison of Segmental Gastrectomy and Distal Gastrectomy with Billroth I Reconstruction for Early Gastric Cancer That's Developed on the Gastric Body

PURPOSE: Subtotal distal gastrectomy has been accepted as the standard treatment for early gastric cancer that's developed on the gastric body. EMR and ESD have been introduced to minimize the incidence of postgastrectomy syndrome, but these procedures can not detect lymph node metastasis and they have a risk for gastric perforation. Segmental gastrectomy has recently been applied for treating early gastric cancer, but its usefulness has not been clarified. The aim of this study was to compare segmental gastrectomy and distal gastrectomy with Billroth I reconstruction for treating early gastric cancer that's developed on the gastric body. MATERIALS AND METHODS: We performed a retrospective review of all the patients who were diagnosed as having early gastric cancer that developed on the gastric body at Chungnam National University Hospital from January 2004 through July 2007. During this period, 41 patients received segmental gastrectomy and 40 patients underwent subtotal distal gastrectomy. All the patients were studied via a biannual review of the body systems, a physical examination, endoscopy, computed tomography and the laboratory findings. RESULTS: There were no significantly differences of the clinicopathologic characteristics between the two groups. The changes of the nutritional status (Hb, TP, Alb and TC) and the body weight change were not significantly different between the 2 groups. There were significantly more residual food in the SG group than that in the SDG group (RGB classification, Residual>Grade 2), but there were no differences for epigastric discomfort (P>0.05). Esophagitis developed at a similar rate for both two groups (LA classification, >Grade A), and bile reflux was found in only one patient of each group. CONCLUSION: We expected the reduction of esophagitis and gastritis and the improvement of nutritional status according to the type of procedure. Yet the results of our study showed no significant differences between the two study groups. More patients and a longer follow up time are needed for determining the advantage sand disadvantages of segmental gastrectomy.

The Early Experience with a Laparoscopy-assisted Pylorus-preserving Gastrectomy: A Comparison with a Laparoscopy-assisted Distal Gastrectomy with Billroth-I Reconstruction

PURPOSE: Pylorus-preserving gastrectomy (PPG), which retains pyloric ring and gastric function, has been accepted as a function-preserving procedure for early gastric cancer for the prevention of postgastrectomy syndrome. This study was compared laparoscopy-assisted pylorus-preerving gastrectomy (LAPPG) with laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction (LADGB I). MATERIALS AND METHODS: Between November 2006 and September 2007, 39 patients with early gastric cancer underwent laparoscopy-assisted gastrectomy in the Department of Surgery at Korea Cancer Center Hospital. 9 of these patients underwent LAPPG and 18 underwent LADGBI. When LAPPG was underwent, we preserved the pyloric branch, hepatic branch, and celiac branch of the vagus nerve, the infrapyloric artery, and the right gastric artery and performed D1+beta lymphadenectomy to the exclusion of suprapyloric lymph node dissection. The distal stomach was resected while retaining a 2.5~3.0 cm pyloric cuff and maintaining a 3.0~4.0 cm distal margin for the resection. RESULTS: The mean age for patients who underwent LAPPG and LADGBI were 59.9+/-9.4 year-old and 64.1+/-10.0 year-old, respectively. The sex ratio was 1.3:1.0 (male 5, female 4) in the LAPPG group and 2.6:1.0 (male 13, female 5) in the LADGBI group. Mean total number of dissected lymph nodes (28.3+/-11.9 versus 28.1+/-8.9), operation time (269.0+/-34.4 versus 236.3+/-39.6 minutes), estimated blood loss (191.1+/-85.7 versus 218.3+/-150.6 ml), time to first flatus (3.6+/-0.9 versus 3.5+/-0.8 days), time to start of diet (5.1+/-0.9 versus 5.1+/-1.7 days), and postoperative hospital stay (10.1+/-4.0 versus 9.2+/-3.0 days) were not found significant differences (P>0.05). The postoperative complications were 1 patient with gastric stasis and 1 patient with wound seroma in LAPPG group and 1 patient with left lateral segment infarct of liver in the LADGB I group. CONCLUSION: Patients treated by LAPPG showed a comparable quality of surgical operation compared with those treated by LADGBI. LAPPG has an important role in the surgical management of early gastric cancer in terms of quality of postoperative life. Randomized controlled studies should be undertaken to analyze the optimal survival and long-term outcomes of this operative procedure.

Comparison of the Results in Gastric Carcinoma Patients undergoing Billroth I and Billroth II Gastrectomiesy

PURPOSE: The proper reconstruction technique to use after a distal subtotal gastrectomy for a gastric carcinoma, there has been a subject for debated what is the proper reconstruction technique. The aim of this study was to compare the gastric- emptying time and the quality of life following both B-I and B-II reconstructions after a distal gastrectomy for a gastric adenocarcinoma. MATERIALS AND METHODS: We studied 122 patients who had undergone a distal gastrectomy for a gastric adenocarcinoma between June 1999 and July 2002 at our hospital. 51 patients underwent B-I group, and 71 patients underwent B-II group. To evaluate the gastric-emptying time, we analyzed the T1/2 time by means of radionuclide scintigraphy using a gamma camera after ingestion of an (99m)Tc-tin-colloid steamed egg. The nutritional status was measured by the weight change. Postgastrectomy syndrome was evaluated using an abdominal symptoms survey. Dumping syndrome was measured using the Sigstad dumping score. RESULTS: The gastric-emptying time was somewhat delayed in the B-I group after a 6 month period, but there was no difference after 12 months between the two groups. There was less weight loss in the B-I group than in the B-II group (P=0.023). Fewer abdominal symptoms were occurred in the B-I group than in the B-II group. Dumping syndrome occurred less frequently in the B-I group than in the B-II group (P=0.013). CONCLUSION: In our study, the Billroth I reconstruction led to less weight loss, a better nutritional status, and a better quality of life than the Billroth II reconstruction. We concluded that after a distal subtotal gastrectomy, the Billroth I reconstruction would be considered when the procedure is oncologically suitable.

Comparison of an Uncut Roux-en-Y Gastrojejunostomy with a Billroth I Gastroduodenostomy after Totally Laproscopic Distal Gastrectomy

PURPOSE: An uncut Roux-en-Y gastrojejunostomy has been known to be effective in preventing bile reflux gastritis in the remnant stomach and the Roux stasis syndrome. MATERIALS AND METHODS: To evaluate the usefulness of a totally laparoscopic uncut Roux-en-Y gastrojejunostomy (TLuRYGJ) after a distal gastrectomy, we reviewed the medical records of 19 consecutive patients that underwent a TLuRYGJ at our institution, and 11 consecutive patients who underwent a totally laparoscopic Billroth I gastrectomy (TLB-I) during the same period. RESULTS: Postoperative gastrointestinal symptoms related to the postgastrectomy syndrome and the Visick classification at six months after surgery were not different in the two groups; however, there was no case of symptomatic bile reflux gastritis and only one case of delayed gastric empting, for which medication was required, in the TLuRYGJ group. The endoscopic findings of the remnant stomach for bile reflux gastritis at six months after surgery were better in the TLuRYGJ group than in the TLB-I group. CONCLUSION: A TLuRYGJ was found to be effective in preventing bile reflux gastritis and the Roux stasis syndrome.

A rare cause of haematemesis: retrograde jejunogastric intussusception.

Retrograde Jejunogastric intussusception is a well-recognised, rare but potentially fatal, long-term complication of gastro-jejunostomy or Billroth-II reconstruction. Only about 200 cases have been reported in literature to date. Diagnosis of this condition is difficult in most of the cases. To avoid mortality early diagnosis and prompt surgical intervention is mandatory. Since gastrojejunostomies with vagotomy are on a declining trend, it is extremely rare to come across such a complication. We report such a case that presented with haematemesis.

Laparoscopic jejuno-jejunostomy for afferent loop stasis following truncal vagotomy with posterior gastro-jejunostomy for pyloric stenosis.

A 47-year-old man presented with epigastric pain relieved by bilious vomiting since one month. He had undergone truncal vagotomy with posterior gastrojejunostomy for benign gastric outlet obstruction 2 years ago. Endoscopy showed distension and stasis in the afferent loop, bile gastritis and esophagitis. Laparoscopic Braun jejunojejunostomy relieved his symptoms.

Complicações da cirurgia gástrica / Complications of Gastric Surgery

Os autores fazem uma revisão bibliográfica sobre as principais complicações tardias que podem ocorrer após cirurgias gástricas, abordando aspectos importantes de sua patogenia, apresentação clínica, diagnóstico e terapêutica.

Totally Laparoscopic Pylorus-preserving Gastrectomy with D2 Lymph Node Dissection

To improve postoperative quality of life, and to avoid postgastrectomy syndrome, pylorus-preserving gastrectomy (PPG) is considered as a good option in the middle third early gastric cancer. Convetional PPG has limitation in number 5 lymph node dissection because of preservation of blood supply and nerve innervation to the pylorus. To expand the indication of PPG, limitation on lymph node dissection must be overcomed. In case of laparoscopic PPG, there have been few reports in the literature. Herein we report a case of totally laparoscopic PPG with D2 lymph node dissection with review of literature.

Total gastrectomy with substitution of stomach by jejunal pouch with and without duodenal passage: study in rats

OBJETIVO: Estudo comparativo foi realizado entre a bolsa jejunal de Fernando Paulino (FP) e uma bolsa jejunal (JP) interposta entre o esôfago e duodeno, para substituir o estômago após gastrectomia . Foi investigado o efeito dos dois procedimentos na histologia do esôfago, estado nutricional e gastrinemia sérica em ratos. MÉTODOS: Quarenta e seis ratos Wistar pesando 282±17g foram aleatoriamente submetidos a sham operation (S), FP e JP após gastectomia total. Decorridas 8 semanas, foi colhido sangue por punção cardíaca para dosagem de proteínas totais, albumina, ferro, transferrina, folato, cobalamina, calcio, e gastrina. Os animais receberam dose letal de anestésico e tecido do esôfago terminal foi retirado para histologia. Foi observada a mortalidade operatória dos animais. RESULTADOS: Quarenta e seis ratos foram operados e 30 sobreviveram por 8 semanas. Cinco (33,3 %) morreram após FP e 11 (52,3%) após JP (p<0.05). Esophagitis pós-operatória ocorreu em 6 ratos JP. Na 8ª semana o peso corporal foi maior nosratos submetidos a FP do que JP (p>0.05). Os ratos submetidos a JP tiveram uma diminuição significativa na albumina, glucose, transferrina, ferro, folato e cálcio, comparado com o sham (p<0.05). Os níveis de gastrina sérica, ferro e calcio mostraram-se significantemente maiores nos ratos submetidos a JP do que nos FP (p<0.05). Nos ratos FP a transferrina e a cobalamina estiveram significantemente diminuídas comparando-se os níveis do pré-operatório com a 8ª semana (p<0.05). CONCLUSÃO: A bolsa jejunal de F. Paulino, em ratos, resultou em mortalidade operatória e incidência de esofagite de refluxo menor do que a interposição de JP. A JP não afetou a dosagem sérica de gastrina, ferro e cálcio, provavelmente devido à preservação da passagem dos alimentos pelo duodeno.

Assistência de enfermagem no pós-operatório de gastrectomia / Nursing care of postoperative gastrectomy

O presente trabalho monográfico é resultado de um estudo qualitativo que teve como objetivo otimizar a atuação do enfermeiro na prevenção das complicações pós-cirúrgicas de gastrectomia por câncer. A escolha do tema foi originado pelo crescente número de casos admitidos para tratamento em uma instituição da rede de saúde pública federal, especializada em oncologia, na cidade do Rio de Janeiro, na qual tem sido observadas complicações pós-cirúrgicas que podem ser prevenidas ou minimizadas na sua incidência. Diversos autores já estudaram estas complicações e as intervenções necessárias, e neste trabalho as mesmas serão descritas, desta forma contribuindo para a atuação da enfermagem em oncologia. Este estudo é baseado no conceito de enfermagem segundo Horta para quem assistir em enfermagem é "fazer pelo ser humano aquilo que ele não pode fazer por si mesmo". Pretendemos com este estudo descrever as principais complicações pós-cirúrgicas de gastrectomia por câncer, bem como a intervenção do enfermeiro.

Immunologic changes to autologous transfusion after operational trauma in malignant tumor patients: neopterin and interleukin-2 / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECTIVE</b>To estimate the impact of autologous transfusion on the status of perioperative immune activation in malignant tumor patients. The Serum Neopterin and Interleukin-2 (IL-2) were measured.</p><p><b>METHODS</b>Sixty patients undergoing elective radical resection for malignant stomach tumor were enrolled in the prospective study and assigned to the following groups: (1) Group A received autologous transfusion. (2) Group H received allogeneic transfusion. The perioperative course (Before induction of anesthesia, after operation and 5 d after operation) of Neopterin and IL-2 was compared.</p><p><b>RESULTS</b>In group A, Serum Neopterin was significantly lower than baseline after operation and IL-2 had no significant changes. In group H, both Serum Neopterin and IL-2 were significantly lower than baseline after operation and 5 d after operation. Compared with group A, Serum Neopterin was significantly lower than baseline after operation and 5 d after operation and IL-2 was significantly lower than baseline 5 d after operation.</p><p><b>CONCLUSION</b>Autologous transfusion decreased the perioperative immune suppression in malignant stomach tumor patients.</p>

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.