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1.
J Clin Endocrinol Metab ; 106(10): e4192-e4201, 2021 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-33870426

RESUMO

INTRODUCTION: Patients with type 2 diabetes experience resolution of hyperglycemia within days after Roux-en-Y gastric bypass (RYGB) surgery. This is attributed, in part, to enhanced secretion of hindgut factors following exclusion of the gastric remnant and proximal intestine during surgery. However, evidence of the mechanisms of remission remain limited due to the challenges of metabolic evaluation during the early postoperative period. The purpose of this investigation was to determine the role of foregut exclusion in the resolution of type 2 diabetes after RYGB. METHODS: Patients with type 2 diabetes (n = 15) undergoing RYGB had a gastrostomy tube (G-tube) placed in their gastric remnant at time of surgery. Patients were randomized to receive a mixed meal tolerance test via oral or G-tube feeding immediately prior to and 2 weeks after surgery in a repeated measures crossover design. Plasma glucose, insulin, C-peptide, incretin responses, and indices of meal-stimulated insulin secretion and sensitivity were determined. RESULTS: Body weight, fat mass, fasting glucose and insulin, and circulating lipids were significantly decreased 2 weeks after surgery. The glycemic response to feeding was reduced as a function of total area under the curve but not after adjustment for the reduction in fasting glucose. Oral feeding significantly enhanced insulin and incretin secretion after RYGB, which was entirely ablated by G-tube feeding. CONCLUSION: Foregut exclusion accounts for the rise in incretin and insulin secretion but may not fully explain the early improvements in glucose metabolism after RYGB surgery.


Assuntos
Diabetes Mellitus Tipo 2/cirurgia , Nutrição Enteral , Derivação Gástrica , Incretinas/sangue , Secreção de Insulina/fisiologia , Adolescente , Adulto , Área Sob a Curva , Glicemia/metabolismo , Composição Corporal , Estudos Cross-Over , Diabetes Mellitus Tipo 2/fisiopatologia , Métodos de Alimentação , Feminino , Coto Gástrico/fisiopatologia , Controle Glicêmico , Humanos , Análise de Intenção de Tratamento , Masculino , Refeições/fisiologia , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
2.
Curr Oncol ; 27(3): e259-e264, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32669931

RESUMO

Background: Gastric stump ("remnant") cancer is the development of a malignancy related to previous gastric surgery. Prognosis in gastric stump cancer, compared with that in primary gastric cancer, is still controversial. Methods: From January 1988 to December 2012 at a single medical centre in Taiwan, 105 patients with gastric stump cancer, including 85 with previous peptic ulcer disease and 20 with previous gastric cancer, were analyzed for clinicopathologic characteristics and overall survival (os). Results: The 5-year os rates for patients with gastric stump cancer and with primary gastric cancer were 51.2% and 54.5% respectively (p = 0.035). Analysis of clinicopathologic characteristics indicated that, compared with patients having primary gastric cancer, those with gastric stump cancer had more lymph node metastasis (p < 0.001) and had been diagnosed at a more advanced stage (p = 0.047). Multivariate analysis with os as an endpoint showed that age [p = 0.015; hazard ratio (hr): 2.300; 95% confidence interval (ci): 1.173 to 4.509], tumour size (p = 0.037; hr: 1.700; 95% ci: 1.031 to 2.801), stromal reaction (p = 0.021; hr: 1.802; 95% ci: 1.094 to 2.969), and pathologic N category (p = 0.001; hr: 1.449; 95% ci: 1.161 to 1.807) were independent predictors in gastric stump cancer. The os rates for patients with gastric stump cancer who previously had gastric cancer or peptic ulcer disease were 72.9% and 50.0% respectively (p = 0.019). The Borrmann classification was more superficial (p = 0.005), lymph node metastases were fewer (p = 0.004), and staging was less advanced (p = 0.025) in patients with gastric stump cancer who previously had gastric cancer than in their counterparts who previously had peptic ulcer disease. Conclusions: Survival is poorer in patients with gastric stump cancer who previously had peptic ulcer disease than in those who previously had primary gastric cancer. Patients with gastric stump cancer who previously had gastric cancer and could receive curative gastrectomy tended to have a better prognosis because of a more superficial Borrmann classification. Regular follow-up in patients who have undergone gastric surgery is recommended for the early detection of gastric stump cancer.


Assuntos
Coto Gástrico/fisiopatologia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/mortalidade , Análise de Sobrevida
3.
J Diabetes Res ; 2020: 7058145, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32509882

RESUMO

BACKGROUND: Postsurgical gastroparesis syndrome (PGS) after subtotal gastrectomy imposes significant social and economic burdens. We aimed to investigate the relationship between preoperative blood glucose level and PGS and develop a nomogram for individualized prediction. Patients and Methods. We retrospectively analyzed 633 patients with gastric cancer who underwent subtotal gastrectomy. Preoperative blood glucose levels were evaluated via receiver operating characteristic (ROC) curve analysis. Chi-squared tests and multivariable logistic regression analyses were used to develop a predictive model for PGS, presented as a nomogram, which was assessed for its clinical usefulness. RESULTS: Thirty-eight of 633 patients were diagnosed with PGS. Based on the ROC curve analysis, the preoperative blood glucose cutoff value for PGS was 6.25 mmol/L. The predictors of PGS included preoperative hyperglycemia (odds ratio (OR) 2.3, P = 0.03), body mass index (BMI; OR 0.21, P = 0.14 for BMI < 18.5 and OR 3.0, P = 0.004 for BMI > 24), and the anastomotic method (OR 7.3, P = 0.001 for Billroth II and OR 5.9, P = 0.15 for Roux-en-Y). The predictive model showed good discrimination ability, with a C-index of 0.710, and was clinically useful. CONCLUSIONS: Preoperative hyperglycemia effectively predicts PGS. We present a nomogram incorporating the preoperative blood glucose level, BMI, anastomotic method, and tumor size, for individualized prediction of PGS.


Assuntos
Glicemia/análise , Gastrectomia/efeitos adversos , Gastroparesia/diagnóstico , Nomogramas , Complicações Pós-Operatórias/diagnóstico , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia/metabolismo , China , Complicações do Diabetes/sangue , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/cirurgia , Jejum/sangue , Feminino , Gastrectomia/métodos , Coto Gástrico/fisiopatologia , Gastroparesia/sangue , Gastroparesia/etiologia , Humanos , Individualidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/sangue , Neoplasias Gástricas/diagnóstico , Síndrome , Resultado do Tratamento
4.
Surg Oncol ; 31: 75-82, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31541910

RESUMO

BACKGROUND: In gastrectomy for gastric cancer, oncologic safety including secure resection margin is considered important while less attention is given to maximizing remnant stomach volume (RSV). Nutrition and body composition are important postoperative factors for patient well-being. In this prospective observational study, we investigated the effects of RSV and anastomosing method on nutrition, anemia, and body composition change. METHODS: We enrolled 247 patients who underwent curative laparoscopic gastrectomy (Billroth-1: 111, Billroth-2: 31, Roux-en-Y: 38, total gastrectomy: 67) for stage 1 gastric cancer between 2015 and 2016. Their clinicodemographic characteristics and laboratory data were collected. RSV, area of abdominal muscle, and subcutaneous/visceral fat were measured using CT data. RESULTS: Patients with larger RSV and those who underwent Billroth-1 exhibited smaller reduction in hemoglobin and nutritional parameters during the first three postoperative months, and showed better recovery in the aforementioned variables as well in the first postoperative year. Visceral fat was the most affected factor by gastrectomy, and abdominal muscle and subcutaneous/visceral fat were better preserved in patients with larger RSV. The proportion of sarcopenic patients was also the smallest in the Billroth-1 group and larger RSV group. Patients who underwent total gastrectomy showed the highest degree of deterioration in all parameters. CONCLUSIONS: Estimating RSV and body composition by using CT offers valuable clinical information. The Billroth-1 procedure and larger RSV were associated with better postoperative nutritional variables and reduced prevalence of sarcopenia among gastric cancer patients after gastrectomy. When performing gastrectomy in stage 1 gastric cancer patients, RSV should be considered.


Assuntos
Anastomose Cirúrgica/métodos , Composição Corporal , Gastrectomia/métodos , Coto Gástrico/fisiopatologia , Estado Nutricional , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Feminino , Seguimentos , Hemoglobinas/análise , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Procedimentos de Cirurgia Plástica/métodos
5.
Am J Physiol Gastrointest Liver Physiol ; 317(2): G141-G146, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31169993

RESUMO

Postsurgical gastric dysfunction is common, but the mechanisms are varied and poorly understood. The pylorus normally acts as an electrical barrier isolating gastric and intestinal slow waves. In this report, we present an aberrant electrical conduction pathway arising between the stomach and small intestine, following pyloric excision and surgical anastomosis, as a novel disease mechanism. A patient was referred with postsurgical gastroparesis following antrectomy, gastroduodenostomy, and vagotomy for peptic ulceration. Scintigraphy confirmed markedly abnormal 4-h gastric retention. Symptoms included nausea, vomiting, postprandial distress, and reflux. Intraoperative, high-resolution electrical mapping was performed across the anastomosis immediately before revision gastrectomy, and the resected anastomosis underwent immunohistochemistry for interstitial cells of Cajal. Mapping revealed continuous, stable abnormal retrograde slow-wave propagation through the anastomosis, with slow conduction occurring at the scar (4.0 ± 0.1 cycles/min; 2.5 ± 0.6 mm/s; 0.26 ± 0.15 mV). Stable abnormal retrograde propagation continued into the gastric corpus with tachygastria (3.9 ± 0.2 cycles/min; 1.6 ± 0.5 mm/s; 0.19 ± 0.12 mV). Histology confirmed ingrowth of atypical ICC through the scar, defining an aberrant pathway enabling transanastomotic electrical conduction. In conclusion, a "gastrointestinal aberrant pathway" is presented as a novel proposed cause of postsurgical gastric dysfunction. The importance of aberrant anastomotic conduction in acute and long-term surgical recovery warrants further investigation.NEW & NOTEWORTHY High-resolution gastric electrical mapping was performed during revisional surgery in a patient with severe gastric dysfunction following antrectomy and gastroduodenostomy. The results revealed continuous propagation of slow waves from the duodenum to the stomach, through the old anastomotic scar, and resulting in retrograde-propagating tachygastria. Histology showed atypical interstitial cells of Cajal growth through the anastomotic scar. Based on these results, we propose a "gastrointestinal aberrant pathway" as a mechanism for postsurgical gastric dysfunction.


Assuntos
Cicatriz , Duodeno , Condutividade Elétrica , Gastrectomia/efeitos adversos , Coto Gástrico , Gastroparesia , Células Intersticiais de Cajal/patologia , Complicações Pós-Operatórias , Anastomose Cirúrgica/efeitos adversos , Cicatriz/etiologia , Cicatriz/patologia , Cicatriz/fisiopatologia , Duodeno/inervação , Duodeno/patologia , Duodeno/fisiopatologia , Impedância Elétrica , Esvaziamento Gástrico , Coto Gástrico/inervação , Coto Gástrico/patologia , Coto Gástrico/fisiopatologia , Gastroparesia/etiologia , Gastroparesia/fisiopatologia , Gastroparesia/cirurgia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos
6.
Gen Thorac Cardiovasc Surg ; 67(5): 470-478, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30778905

RESUMO

OBJECTIVE: There is no consensus concerning whether the residual stomach should be preserved after esophagectomy for thoracic esophageal cancer patients with previous distal or segmental gastrectomy. The purpose of this retrospective study was to assess the efficacy of preserving the residual stomach after esophagectomy in patients with previous gastrectomy. METHODS: Between 2000 and 2015, 45 consecutive thoracic esophageal cancer patients with previous distal or segmental gastrectomy underwent esophagectomy followed by colon reconstruction. Patients were assigned to two groups according to how the residual stomach was treated (preservation group, n = 11; resection group, n = 34). We compared surgical outcomes and alterations of nutrition status, including the skeletal muscle area, between the two groups. In addition, we investigated the distribution of abdominal lymph node metastases in the resection group. RESULTS: Operative time and blood loss tended to be lower in the preservation group compared to the resection group. However, the difference did not reach statistical significance. The rate of patients decreasing skeletal muscle area after surgery was significantly higher in the resection group (88% vs 50%, P = 0.03). There were no patients with metastatic abdominal lymph nodes when the previous gastrectomy had been performed for gastric cancer and the esophageal cancer was located at the upper or middle esophagus in the resection group. CONCLUSIONS: Preservation of the residual stomach after esophagectomy in esophageal cancer patients with previous gastrectomy may influence the postoperative nutrition status and can be selectively approved.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia , Gastrectomia , Coto Gástrico/fisiopatologia , Fenômenos Fisiológicos da Nutrição , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos
7.
J Invest Surg ; 31(2): 153-162, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28635514

RESUMO

BACKGROUND: The hypothalamic-pituitary-tyhroid axis is directly affected by drastic changes in energy stores. The aim of the present study was to determine the effects of triiodothyronine (T3) treatment on cut-surface healing of remnant stomach with weight loss alterations after sleeve gastrectomy (SG). METHODS: Thirty male Wistar Albino rats were divided into three groups: sham (n = 6), control (n = 12), and experimental (n = 12). Control and experimental group rats underwent sleeve gastrectomy. Experimental group rats received a single dose of T3 (400 mg/100 g) on the first postoperative day whereas control group rats received 0.9% NaCl. All rats were sacrificed on the seventh postoperative day. RESULTS: In the group of rats receiving T3, levels of FT3 were significantly higher and that of FT4 were significantly lower compared with both the control and sham group rats (p <.05). No significant difference was found between control and T3 group rats in terms of weight loss (p >.05). Microscopic examination of the cut surface of remnant stomach in the control group rats revealed significantly more severe tissue necrosis, edema, and disruption of mucosal epithelium than in the T3 group rats (p <.05). On the other hand, bridging of the submucosal and muscular layers, tissue granulation, fibroblast accumulation, neoangiogenesis, and collagen deposition in the T3 group rats were significantly higher than in the control group rats (p <.05). CONCLUSIONS: Sleeve gastrectomy did not significantly alter thyroid hormone levels in short term. T3 hormone therapy seems to deliver constructive therapeutic effects for wound healing while causing no adverse effect on weight reduction.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Gastrectomia/efeitos adversos , Coto Gástrico/fisiopatologia , Obesidade Mórbida/cirurgia , Tri-Iodotironina/uso terapêutico , Cicatrização/efeitos dos fármacos , Animais , Cirurgia Bariátrica/métodos , Gastrectomia/métodos , Masculino , Modelos Animais , Necrose/tratamento farmacológico , Período Pós-Operatório , Ratos , Ratos Wistar , Tiroxina/sangue , Fatores de Tempo , Resultado do Tratamento , Tri-Iodotironina/sangue , Tri-Iodotironina/farmacologia , Redução de Peso/efeitos dos fármacos
8.
Obes Surg ; 27(11): 2845-2854, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28508273

RESUMO

BACKGROUND: Remnant dimension is considered one of the crucial elements determining the success of sleeve gastrectomy (SG), and dilation of the gastric fundus is often believed to be the main cause of failure. OBJECTIVES: The main outcome of this study is to find correlations between remnant morphology in the immediate post-operative stage, its dilation in years, and the long-term results. The second purpose aims to correlate preoperative eating disorders, taste alteration, hunger perception, and early satiety with post-SG results. MATERIALS AND METHODS: Remnant morphology was evaluated, in the immediate post-operative stage and over the years (≥2 years), through X-ray of the oesophagus-stomach-duodenum calculating the surface in anteroposterior (AP) and right anterior oblique projection (RAO). Presurgery diagnosis of eating disorders and their evaluation through "Eating Disorder Inventory-3" (EDI3) during follow-up were performed. Change in taste perception, sense of appetite, and early satiety were evaluated. Patients were divided into two groups: "failed SGs (EWL<50%) and "efficient SGs" (EWL >50%). RESULTS: There were a total of 50 patients (37 F, 13 M), with mean age 52 years, preoperative weight 131 ± 21.8 kg, and BMI 47.4 ± 6.8 kg/m2. Post-operative remnant mean dimensions overlapped between the two groups. On a long-term basis, an increase of 57.2 and 48.4% was documented in the AP and RAO areas respectively. In "failed" SGs, dilation was significantly superior to "efficient" SGs (AP area 70.2 vs 46.1%; RAO area 59.3 vs 39%; body width 102% vs 41.7%). Preoperative eating disorders were more present in efficient SGs than in failed SGs with the exception of sweet eating. There were no significant changes to taste perception during follow-up. Fifty-two percent of efficient SGs vs 26% of failed SGs reported a persistent lack of sense of hunger; similarly, 92.5 vs 78% declared the persistence of a sense of early satiety. The two groups did not statistically differ as far as all the variables of the EDI3 are concerned. CONCLUSION: On a long-term basis, the remnant mean dilation is around 50% compared to the immediate post-operative stage but failed SGs showed larger remnant dilation than efficient SGs and, in percentage, the more dilated portion is the body of the stomach. As far as all the EDI3 variables obtained are concerned, the two groups did not statistically differ. Of all eating disorders, sweet eating seems to be weakly connected to SG failure.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Gastrectomia/reabilitação , Coto Gástrico , Obesidade Mórbida/cirurgia , Adulto , Duodeno/cirurgia , Transtornos da Alimentação e da Ingestão de Alimentos/cirurgia , Feminino , Seguimentos , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Coto Gástrico/patologia , Coto Gástrico/fisiopatologia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/reabilitação , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/patologia , Obesidade Mórbida/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Redução de Peso/fisiologia
9.
Obes Surg ; 27(7): 1901-1905, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28508274

RESUMO

BACKGROUND: Morpho-functional modifications of the gastric remnant after Roux-en-Y gastric bypass (RYGB) have not been completely defined, due to its inaccessibility for bioptic mapping. The aim of the study is to evaluate such modifications using Gastropanel®, a non-invasive blood test cross-checking four gastric biomarkers, able to provide a snapshot of mucosa conditions. SUBJECTS AND METHODS: Twenty-four women undergoing RYGB were prospectively enrolled. Gastropanel® parameters (pepsinogens, Gastrin-17 and immunoglobulins against Helicobacter pylori), biometrical/clinical data were collected preoperatively and at 6-months follow-up. RESULTS: All parameters showed significant reduction (p < 0.05). Pepsinogen I reduction correlated with BMI percent decrease. CONCLUSIONS: The exclusion of food transit is responsible for significant drop in gastric output, hardly representing a risk factor in the remnant carcinogenesis, being unexposed to alimentary carcinogenic agents.


Assuntos
Coto Gástrico/fisiopatologia , Gastrinas/sangue , Imunoglobulina G/sangue , Obesidade Mórbida/sangue , Obesidade Mórbida/cirurgia , Pepsinogênios/sangue , Adulto , Biomarcadores/sangue , Feminino , Derivação Gástrica , Helicobacter pylori/imunologia , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Morbidade , Obesidade Mórbida/fisiopatologia , Estudos Prospectivos , Redução de Peso
10.
Zhonghua Wei Chang Wai Ke Za Zhi ; 20(4): 393-397, 2017 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-28440519

RESUMO

Surgical operation in treating obesity and type 2 diabetes is popularizing rapidly in China. Correct prevention and recognition of perioperation-related operative complications is the premise of ensuring surgical safety. Familiar complications of the operation include deep venous thrombosis, pulmonary artery embolism, anastomotic bleeding, anastomotic fistula and marginal ulcer. The prevention of deep venous thrombosis is better than treatment. The concrete measures contain physical prophylaxis (graduated compression stocking and intermittent pneumatic compression leg sleeves) and drug prophylaxis (unfractionated heparin and low molecular heparin), and the treatment is mainly thrombolysis or operative thrombectomy. The treatment of pulmonary artery embolism includes remittance of pulmonary arterial hypertension, anticoagulation, thrombolysis, operative thrombectomy, interventional therapy and extracorporeal membrane oxygenation (ECMO). Hemorrhage is a rarely occurred but relatively serious complication after bariatric surgery. The primary cause of anastomotic bleeding after laparoscopic gastric bypass is incomplete hemostasis or weak laparoscopic repair. The common bleeding site in laparoscopic sleeve gastrectomy is gastric stump and close to partes pylorica, and the bleeding may be induced by malformation and weak repair technique. Patients with hemodynamic instability caused by active bleeding or excessive bleeding should timely received surgical treatment. Anastomotic fistula in gastric bypass can be divided into gastrointestinal anastomotic fistula and jejunum-jejunum anastomotic fistula. The treatment of postoperative anastomotic fistula should vary with each individual, and conservative treatment or operative treatment should be adopted. Anastomotic stenosis is mainly related to the operative techniques. Stenosis after sleeve gastrectomy often occurs in gastric angle, and the treatment methods include balloon dilatation and stent implantation, and surgical treatment should be performed when necessary. Marginal ulcer after gastric bypass is a kind of peptic ulcer occurring close to small intestine mucosa in the junction point of stomach and jejunum. Ulcer will also occur in the vestige stomach after laparoscopic sleeve gastrectomy, and the occurrence site locates mostly in the gastric antrum incisal margin. Preoperative anti-HP (helicobacter pylorus) therapy and postoperative continuous administration of proton pump inhibitor (PPI) for six months is the main means to prevent and treat marginal ulcer. For patients on whom conservative treatment is invalid, endoscopic repair or surgical repair should be considered. Different surgical procedures will generate different related operative complications. Fully understanding and effectively dealing with the complications of various surgical procedures through multidisciplinary cooperation is a guarantee for successful operation.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Cirurgia Bariátrica/efeitos adversos , Gastrectomia/efeitos adversos , Derivação Gástrica/efeitos adversos , Hemorragia Gastrointestinal/prevenção & controle , Hemorragia Gastrointestinal/cirurgia , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/terapia , Embolia Pulmonar/terapia , Trombose Venosa/prevenção & controle , Trombose Venosa/terapia , Anticoagulantes/uso terapêutico , Cateterismo , China , Tratamento Conservador , Constrição Patológica/etiologia , Constrição Patológica/terapia , Fístula do Sistema Digestório/etiologia , Fístula do Sistema Digestório/terapia , Endoscopia Gastrointestinal/métodos , Oxigenação por Membrana Extracorpórea , Mucosa Gástrica/patologia , Coto Gástrico/fisiopatologia , Coto Gástrico/cirurgia , Hemorragia Gastrointestinal/etiologia , Hemostasia Cirúrgica/efeitos adversos , Hemostasia Cirúrgica/métodos , Técnicas Hemostáticas , Heparina/uso terapêutico , Humanos , Dispositivos de Compressão Pneumática Intermitente , Intestino Delgado/patologia , Margens de Excisão , Úlcera Péptica/etiologia , Úlcera Péptica/terapia , Embolia Pulmonar/etiologia , Stents , Meias de Compressão , Trombectomia , Terapia Trombolítica , Trombose Venosa/etiologia
11.
Surg Clin North Am ; 97(2): 277-293, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28325187

RESUMO

Postgastrectomy syndromes result from altered form and function of the stomach. Gastrectomy disrupts reservoir capacity, mechanical digestion and gastric emptying. Early recognition of symptoms with prompt evaluation and treatment is essential. Many syndromes resolve with minimal intervention or dietary modifications. Re-operation is not common but often warranted for afferent and efferent loop syndromes and bile reflux gastritis. Preoperative nutritional assessment and treatment of common vitamin and mineral deficiencies after gastrectomy can reduce the incidence of chronic complications. An integrated team approach to risk assessment, patient education, and postoperative management is critical to optimal care of patients with gastric cancer.


Assuntos
Síndromes Pós-Gastrectomia/dietoterapia , Síndrome da Alça Aferente/etiologia , Síndrome da Alça Aferente/cirurgia , Anastomose em-Y de Roux , Refluxo Biliar/etiologia , Diarreia/etiologia , Suplementos Nutricionais , Síndrome de Esvaziamento Rápido/dietoterapia , Síndrome de Esvaziamento Rápido/etiologia , Esvaziamento Gástrico/fisiologia , Coto Gástrico/fisiopatologia , Gastrite/etiologia , Gastroparesia/etiologia , Humanos , Desnutrição/dietoterapia , Desnutrição/etiologia , Síndromes Pós-Gastrectomia/fisiopatologia , Síndromes Pós-Gastrectomia/cirurgia , Reoperação
12.
Gastric Cancer ; 20(3): 457-464, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27638289

RESUMO

PURPOSE: In cases of carcinoma in the remnant stomach (CRS), the lymphatic flow may be altered by the initial surgery. In this study of CRS after gastrectomy, we investigated how the regions of lymph node metastasis and changes in lymphatic flow depend on initial disease status. METHOD: The study included 76 patients with CRS who underwent gastrectomy between September 2002 and November 2014. We analyzed and compared the clinicopathological factors and survival periods between patients after distal gastrectomy for malignant disease (group M, 33 patients) and patients after distal gastrectomy for benign disease (group B, 43 patients). RESULTS: The depth of tumor invasion was more advanced in group B (T1/T2/T3/T4: group M 18/1/7/7, group B 8/11/8/16; P = 0.002). However, the degree of lymph node metastasis did not differ significantly between the two groups. The incidence of lymph node metastasis was high at stations 2 (19 %), 4sa (17 %), 10 (25 %), 11p (19 %), and 11d (27 %) in group M and 1 (14 %), 3 (23 %), and 4sb (15 %), and the mesojejunal lymph node (21 %) in group B. Lymph node dissection was highly beneficial at station 3, station 7, and the mesojejunum in both groups, but not at stations 10 or 11d. CONCLUSION: As compared with group B, group M showed higher incidences of lymph node metastasis in the greater curvature, splenic hilum, and lymph nodes along the splenic artery, suggesting the predominance of lymphatic flows from the greater curvature to the splenic hilum and from the remnant stomach to the splenic artery.


Assuntos
Coto Gástrico/fisiopatologia , Metástase Linfática/patologia , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastrectomia , Humanos , Linfa , Excisão de Linfonodo , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Análise de Sobrevida
13.
World J Surg ; 38(11): 2898-903, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24934641

RESUMO

BACKGROUND: Indications for gastric local resection (LR) include gastrointestinal stromal tumors, neuroendocrine tumors, and early gastric cancer. LR is expected to preserve physiological function and ameliorate postgastrectomy syndrome. METHODS: Gastric emptying was assessed by the (13)C-acetate breath test in 20 healthy volunteers (HVs) and 60 gastrectomized patients [distal gastrectomy with Billroth I reconstruction (DGBI) in 26 patients, LR in 34 patients]. For the (13)C breath test, 100 mg of (13)C-acetate sodium salt was mixed in a test meal. Breath samples were collected before intake and during the next 3 h. We compared the gastric reservoir capacity using the gastric retention rate at 5 min (RR5) and gastric emptying by the half emptying time (T½). Patients completed a questionnaire survey about their symptoms, dietary intake, body weight, and restriction of activities of daily living [reflecting quality of life (QOL)]. RESULTS: The RR5 values for the HV, LR, and DGBI groups were 93.7, 90.0, and 45.3* %, respectively (*compared to HV and LR, p < 0.0001). The T½ values were 23.3, 20.2, and 5.9* min, respectively. Dietary intake and body weight change were significantly more reduced in the DGBI group than the LR group (p < 0.05). Subgroup analysis indicated that the reservoir capacity in those with LR at the lesser curvature was more disturbed than that in patients with LR at the greater curvature. The questionnaire showed no differences in those patients' QOL. CONCLUSIONS: Because the reservoir capacity, the gastric emptying and QOL were maintained, LR is an option for selected patients with early gastric cancer.


Assuntos
Gastrectomia , Coto Gástrico/fisiopatologia , Neoplasias Gástricas/cirurgia , Atividades Cotidianas , Adulto , Peso Corporal , Testes Respiratórios , Feminino , Esvaziamento Gástrico/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Pós-Gastrectomia/fisiopatologia , Qualidade de Vida , Inquéritos e Questionários
14.
Hepatogastroenterology ; 59(118): 1677-81, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22584424

RESUMO

BACKGROUND/AIMS: We compared functional outcomes between different types of reconstruction following open or laparoscopic 1/2- or 2/3-proximal gastrectomy for gastric cancer. METHODOLOGY: Resection and reconstruction were performed by one of the following 6 methods, depending on the depth of cancer invasion and the date of the procedure relative to introduction of laparoscopic proximal gastrectomy: open proximal 2/3-gastrectomy with jejunal interposition (2/3 PG-int, n=7), open proximal 1/2-gastrectomy with jejunal interposition (1/2 PG-int, n=5), laparoscopic proximal 1/2-gastrectomy followed by double tract reconstructions with small (3 cm) jejunogastrostomy (L1/2 PG-DT(S), n=19) and laparoscopic proximal 1/2-gastrectomy followed by double tract reconstructions with large (6 cm) jejunogastrostomy (L1/2PG-DT(L), n=10). Open total gastrectomy with jejunal interposition (TG, n=12) and laparoscopic total gastrectomy with Roux-en-Y reconstruction (LTG, n=14) represented control procedures. RESULTS: Comparison of postoperative/preoperative body weight ratios and food intake ratios revealed better preservation among patients with a larger remnant stomach and with easy flow of food into the remnant stomach (the 1/2PG-int and L1/2PG-DT(L) groups). CONCLUSIONS: Better functional outcomes were observed in patients with a large remnant stomach and with easy flow of food into the remnant stomach regardless of whether they underwent open or laparoscopic procedures.


Assuntos
Carcinoma/cirurgia , Gastrectomia/métodos , Coto Gástrico/fisiopatologia , Laparoscopia , Procedimentos de Cirurgia Plástica , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose em-Y de Roux , Peso Corporal , Carcinoma/patologia , Digestão , Ingestão de Alimentos , Feminino , Gastroenterostomia , Humanos , Japão , Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Procedimentos de Cirurgia Plástica/métodos , Recuperação de Função Fisiológica , Neoplasias Gástricas/patologia , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
16.
Hepatogastroenterology ; 59(119): 2335-8, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22246212

RESUMO

BACKGROUND/AIMS: Effectiveness of gastric emptying after pylorus-preserving gastrectomy (PPG) remains unclear and a method for continuous assessment is needed. We assessed post-PPG gastric emptying with a continuous real-time ¹³C breath test (BreathID system, Oridion, Israel). METHODOLOGY: Gastric emptying function was assessed by ¹³C breath test in 12 post-PPG patients and 9 post-distal gastrectomy (DG) patients. Continuous ¹³C-acetic acid breath test was performed using the BreathID system. Endoscopic study was also completed. RESULTS: Diarrhea was significantly less common in PPG than DG patients (p=0.021). No other questionnaire items and endoscopic findings showed a significant difference. In the ¹³C-acetic acid breath test, the gastric emptying coefficient (GEC) was significantly greater in PPG than DG patients (p=0.025). No other test parameters showed a significant difference. CONCLUSIONS: Emptying function in the remnant stomach was assessed successfully by the continuous ¹³C-acetic acid breath test. A greater GEC suggested better gastric emptying in PPG patients.


Assuntos
Testes Respiratórios , Gastrectomia/métodos , Esvaziamento Gástrico , Coto Gástrico/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Neoplasias Gástricas/cirurgia , Ácido Acético/metabolismo , Idoso , Biomarcadores/metabolismo , Isótopos de Carbono , Distribuição de Qui-Quadrado , Diarreia/etiologia , Diarreia/fisiopatologia , Feminino , Gastrectomia/efeitos adversos , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/metabolismo , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Fatores de Tempo , Resultado do Tratamento
17.
Surg Today ; 41(5): 680-7, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21533941

RESUMO

PURPOSE: To investigate the phenomenon of remnant gastric motility and emptying after local resection. METHODS: Fifteen dogs were divided into three groups: a control (CONT) group, a group that underwent local resection of the greater (GREAT) curvature, and a group that underwent resection of the lesser (LESS) curvature. We conducted a strain gauge force transducer study, a [(13)C]octanoic acid breath test ((13)C-OBT), and a mosapride citrate effect test. Based on these results, we worked out the receptive relaxation (RR), motility index (MI), and postprandial period (PP) in the postprandial state, and the frequency, duration, and MI of phase III in the fasted state. The half emptying time (T (1/2)) of (13)C-OBT was also calculated. The MI was compared according to the mosapride effect test results. RESULTS: Postprandial RR, antro-pyloro-duodenal coordination, and fasting contractions were maintained in all three groups. Receptive relaxation was significantly shorter in the LESS group than in the other groups. Motility index was significantly lower in both treatment groups than in the CONT group. The PP was significantly longer in the GREAT group than in the other two groups. The (13)CO(2) excretion curves did not differ significantly among the groups. The duration of phase III was remarkably less in the treatment groups than in the CONT group, and MI was significantly lower in the LESS group than in the other groups in the fasted state. The MI increased remarkably after mosapride administration in the CONT group, showing no differences in other objective groups. CONCLUSION: Gastric function was maintained after gastric local resection, although its motility decreased.


Assuntos
Gastrectomia , Coto Gástrico/fisiopatologia , Motilidade Gastrointestinal , Animais , Testes Respiratórios , Caprilatos/metabolismo , Digestão , Cães , Duodeno/fisiopatologia , Jejum/fisiologia , Esvaziamento Gástrico , Jejuno/fisiopatologia , Período Pós-Prandial , Antro Pilórico/fisiopatologia , Piloro/fisiopatologia , Transdutores
18.
Obes Surg ; 18(9): 1083-8, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18535864

RESUMO

BACKGROUND: Aiming to clarify the mechanism of weight loss after the restrictive bariatric procedure of sleeve gastrectomy (LSG), the volumes and pressures of the stomach, of the removed part, and of the remaining sleeve were measured in 20 morbidly obese patients. METHODS: The technique used consisted of occlusion of the pylorus with a laparoscopic clamp and of the gastroesophageal junction with a special orogastric tube connected to a manometer. Instillation of methylene-blue-colored saline via the tube was continued until the intraluminal pressure increased sharply, or the inflated stomach reached 2,000 cc. After recording of measurements, LSG was performed. RESULTS: Mean volume of the entire stomach was 1,553 cc (600-2,000 cc) and that of the sleeve 129 cc (90-220 cc), i.e., 10% (4-17%) and that of the removed stomach was 795 cc (400-1,500 cc). The mean basal intragastric pressure of the whole stomach after insufflations of the abdominal cavity with CO(2) to 15 mmHg was 19 mmHg (11-26 mmHg); after occlusion and filling with saline it was 34 mmHg (21-45 mmHg). In the sleeved stomach, mean basal pressure was similar 18 mmHg (6-28 mmHg); when filled with saline, pressure rose to 43 mmHg (32-58 mmHg). The removed stomach had a mean pressure of 26 mmHg (12-47 mmHg). There were no postoperative complications and no mortality. CONCLUSIONS: The notably higher pressure in the sleeve, reflecting its markedly lesser distensibility compared to that of the whole stomach and of the removed fundus, indicates that this may be an important element in the mechanism of weight loss.


Assuntos
Gastrectomia , Coto Gástrico/patologia , Laparoscopia , Obesidade Mórbida/patologia , Obesidade Mórbida/cirurgia , Adulto , Complacência (Medida de Distensibilidade) , Feminino , Coto Gástrico/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/fisiopatologia , Tamanho do Órgão , Pressão , Estudos Prospectivos , Redução de Peso , Adulto Jovem
19.
J Surg Oncol ; 98(1): 11-4, 2008 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-18461561

RESUMO

BACKGROUND AND OBJECTIVES: Food retention and bile reflux has been frequently observed in gastric cancer patients following a subtotal gastrectomy. The aim of this study was to determine whether reconstruction methods after the distal subtotal gastrectomy influenced the degree of food residue and bile reflux. METHODS: The prospectively collected data was reviewed retrospectively for 522 patients with early gastric cancer who had undertaken a follow-up endoscopic examination after a distal subtotal gastrectomy between 2003 and 2006. RESULTS: The incidence of food retention was 55.5%, 31.9%, and 20.9% at 3, 12, and 24 months after distal subtotal gastrectomy, respectively. The food residue score was higher in the Billroth I (stapling) group than the Billroth II (hand sewing) group at 3 months after surgery (P = 0.006). The incidence of bile reflux was higher in the Billroth II group than in the Billroth I group at 12 and 24 months after surgery (P < 0.001, P = 0.002, respectively). No significant association was found between the food retention and body weight changes. CONCLUSIONS: Food retention was detected in lots of patients after subtotal gastrectomy and the reconstructive methods after subtotal gastrectomy was not relevant to food retention.


Assuntos
Gastrectomia/efeitos adversos , Gastrectomia/métodos , Esvaziamento Gástrico , Coto Gástrico/fisiopatologia , Síndromes Pós-Gastrectomia/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Refluxo Biliar/etiologia , Refluxo Biliar/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Pós-Gastrectomia/etiologia , Síndromes Pós-Gastrectomia/fisiopatologia , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Suturas
20.
Arch Surg ; 142(10): 947-53, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17938307

RESUMO

OBJECTIVE: To evaluate the risk of gastric cancer after Roux-en-Y gastric bypass (RYGB). DESIGN: Rats randomly underwent 1 of the following: RYGB, duodenojejunal bypass (DJB), or a sham operation. Postoperatively, rats underwent a protocol of cancer induction by means of both continuous (200 ppm in tap water for 16 weeks) and intermittent (50-mg/kg intraesophageal injection, once a week, for 12 weeks) administration of N-methyl-N-nitrosourea. SETTING: Institut de Recherche Contre les Canceurs de l'Appareil Digestif-European Institute of Telesurgery. STUDY ANIMALS: Fifty-five Fischer 344 rats. MAIN OUTCOME MEASURES: Seventeen weeks after the operation, we performed a pathologic examination of the whole stomach in all animals to assess for the presence of cancer and/or premalignant lesions. Bilirubin concentration, gastric bacterial flora, and any other pathologic findings were also recorded. RESULTS: In rats in the sham and DJB groups, the incidence of gastric cancer was 85% and 75%, respectively (P = .63), whereas only 23% of rats in the RYGB group developed gastric cancer (4-fold reduction; P = .002). The remnant stomach of rats in the RYGB group also showed a lower bilirubin concentration (P < .01) and a lower bacterial count (P < .05) compared with both the DJB and sham groups. CONCLUSIONS: This study shows that RYGB reduces the risk of gastric cancer in an experimental model of dietary-induced carcinogenesis. Lack of direct contact with carcinogens, lower bile reflux, and a lower bacteria concentration in the gastric content may be responsible for these observations. These data suggest that RYGB may be a safe option for the treatment of morbid obesity even in areas with high gastric cancer incidence.


Assuntos
Derivação Gástrica , Neoplasias Gástricas/etiologia , Neoplasias Gástricas/prevenção & controle , Animais , Bilirrubina/metabolismo , Modelos Animais de Doenças , Suco Gástrico/metabolismo , Suco Gástrico/microbiologia , Coto Gástrico/patologia , Coto Gástrico/fisiopatologia , Masculino , Ratos , Ratos Endogâmicos F344 , Medição de Risco , Neoplasias Gástricas/metabolismo
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