Intussesception after jejunoileal bypass as diagnosed by ultrasound.

Eighty patients who had undergone jejunoileal bypass for morbid obesity were examined by ultrasound at their routine follow-up visits to the clinic. Ultrasonographic evidence of intestinal intussusception was found in 15 patients (19%). Two of these patients were asymptomatic. Ultrasonographic findings were confirmed by operation in 6 patients (5 with intussusception, 1 negative).

Nissen fundoplication for reflux peptic esophagitis.

One hundred sixty-five patients with reflux peptic esophagitis have been treated by Nissen fundoplication. When compared with a group of 104 patients reported five years ago, the incidence of persistent or recurrent esophagitis remains approximately the same (10% versus 8%). This is consistent with the assumption that the Nissen procedure when initially successful tends to remain so and that late recurrence appears to be uncommon. The unpleasant postoperative sequela which we have termed the "gas-bloat syndrome" was noted in 1971 to be present in the early postoperative period in approximately one-half the patients. Late follow-up, however, averaging four years indicates a marked reduction in this disorder with either absence or clinical insignificance in 87% of patients. Nonetheless, moderate symptoms persist in 11% and severe symptoms requiring active treatment in 2%. Manometric study of the lower esophageal sphincter indicates nearly a three-fold increase in resting pressure following Nissen fundoplication (p less than .001). It is hoped that manometric study will provide a more reliable prognostic measure of sphincter restoration than the measurement of pH across the gastroesophageal junction.

Reoperation for postsurgical peptic ulcer recurrence: appraisal of ten years' experience.

Between January 1, 1965 and December 31, 1974, 47 patients were treated at the University of Florida Affiliated Hospitals for peptic ulcer after a generally acceptable ulcer operation. Twenty-seven patients had had vagotomy and drainage, four patients had had vagotomy and antrectomy and 16 patients had had partial gastric resection. Forty-nine definitive operations were performed with a 4% operative mortality. Three patients (7%) had another ulcer recurrence following surgery. Left transthoracic vagotomy is the treatment of choice when recurrent ulceration follows subtotal gastrectomy or vagotomy and antrectomy. For ulceration following vagotomy and drainage, antrectomy, antrectomy is preferred. Synergism between hormonal and neural gastric stimulants causes a decreased parietal cell responsiveness to vagal stimulation after antrectomy. Exploration of the hiatus at the time of antrectomy increases the morbidity of the procedure. Should ulcers recur after antrectomy, vagotomy may be performed with a low morbidity through the transthoracic approach.