Iatrogenic bile duct injury during cholecystectomy presenting after 11 years as a biliary stricture: a case report.

BACKGROUND: Benign biliary stricture is an infrequent condition and the majority occur following cholecystectomy. This case report highlights the occurrence of such a stricture 11 years after cholecystectomy without development of biliary cirrhosis. CASE PRESENTATION: Our patient was a 55-year-old Nepalese woman who presented to our hospital with cholangitis of 1-month duration and a history of cholecystectomy 11 years ago. A diagnosis of benign biliary stricture without features of biliary cirrhosis was made, and the patient was successfully managed with a multidisciplinary approach. CONCLUSION: Benign biliary stricture can present even decades after cholecystectomy. Roux-en-Y hepaticojejunostomy is the treatment of choice, and a long-term favorable outcome can be expected.

Roux-en-Y Plus Distal Jejunal Pouch After Total Gastrectomy: A Prospective Study.

BACKGROUND/AIM: We previously described the safety of distal jejunal pouch with Roux-en-Y reconstruction after total gastrectomy. The present prospective study evaluated its clinical benefit. PATIENTS AND METHODS: Forty-five patients with gastric cancer were preoperatively assigned to groups who underwent Roux-en-Y reconstruction with jejunal pouch (PRY) (n=23) or without pouch (RY) (n=22). Age, sex, grade of lymph node dissection, splenectomy and mode of laparotomy were analyzed, and body mass index (BMI), volume of food intake at one sitting and blood chemistry (total protein, hemoglobin, iron and cholesterol) were periodically assessed in both groups. RESULTS: Post-surgical mortality and severe morbidity did not occur. Three and four patients in the PRY and RY groups, respectively, died of gastric cancer recurrence during the study. BMI at six months after surgery was significantly higher in the PRY than in the RY group (p<0.05). The percentage of food intake at one year after the procedure was significantly higher in the PRY than in the RY group (p<0.05). CONCLUSION: The distal jejunal pouch ameliorated postoperative weight loss and increased food intake. A distal jejunal pouch with PRY reconstruction may confer significant clinical advantages after total gastrectomy. The long-term clinical benefit of this procedure should be evaluated.

Time-Dependent Molecular Responses Differ between Gastric Bypass and Dieting but Are Conserved Across Species.

The effectiveness of Roux-en-Y gastric bypass (RYGB) against obesity and its comorbidities has generated excitement about developing new, less invasive treatments that use the same molecular mechanisms. Although controversial, RYGB-induced improvement of metabolic function may not depend entirely upon weight loss. To elucidate the differences between RYGB and dieting, we studied several individual organ molecular responses and generated an integrative, interorgan view of organismal physiology. We also compared murine and human molecular signatures. We show that, although dieting and RYGB can bring about the same degree of weight loss, post-RYGB physiology is very different. RYGB induces distinct, organ-specific adaptations in a temporal pattern that is characterized by energetically demanding processes, which may be coordinated by HIF1a activation and the systemic repression of growth hormone receptor signaling. Many of these responses are conserved in rodents and humans and may contribute to the remarkable ability of surgery to induce and sustain metabolic improvement.

Manometry of the Upper Gut Following Roux-en-Y Gastric Bypass Indicates That the Gastric Pouch and Roux Limb Act as a Common Cavity.

BACKGROUND: The motility of the upper gut after Roux-en-Y gastric bypass (RYGBP) is underexplored. We aimed to investigate the oesophago-gastro-Roux limb motor activity during fasting and after food intake. METHODS: Eighteen morbidly obese patients were examined at least 2 years after RYGBP. A high-resolution manometry catheter was positioned to straddle the oesophagogastric junction, the gastric pouch and the proximal Roux limb using transmucosal potential difference measurements. Three patients with vertical banded gastroplasty (VBG) were also studied. RESULTS: During the fasting state, the gastric pouch had low or no activity whereas the Roux limb exhibited regular migrating motility complexes (MMCs) being initiated just distal to gastroenteroanastomosis. Median cycle duration was 72 min, and the median propagating velocity of the phase III MMC phase was 2.7 cm/min (n = 8). When patients were asked to eat until they felt comfortably full, intraluminal pressure increased by 6 to 8 cmH2O without any significant difference between gastric pouch and the Roux limb (n = 9). The increased intraluminal pressure following food intake correlated neither to weight loss nor to meal size or rate of eating. CONCLUSIONS: A successful RYGBP is associated with MMC in the Roux limb during fasting. The gastric pouch and the Roux limb behaved as a common cavity during food ingestion. Data do not support the hypothesis that the alimentary limb pressure in response to food intake influences either meal size or weight loss.

Comparative evaluation of two reconstructive methods following laparoscopic assisted subtotal gastrectomy in dogs.

BACKGROUND: Laparoscopic gastrectomy is a new and technically challenging surgical procedure with potential benefit. The objective of this study was to investigate clinical and para-clinical consequences following Roux-en-Y and Jejunal Loop interposition reconstructive techniques for subtotal gastrectomy using laparoscopic assisted surgery. RESULTS: Following resection of the stomach attachments through a laparoscopic approach, stomach was removed and reconstruction was performed with either standard Roux-en-Y (n = 5) or Jejunal Loop interposition (n = 5) methods. Weight changes were monitored on a daily basis and blood samples were collected on Days 0, 7 and 21 post surgery. A fecal sample was collected on Day 28 after surgery to evaluate fat content. One month post surgery, positive contrast radiography was conducted at 5, 10, 20, 40, 60 and 90 minutes after oral administration of barium sulfate, to evaluate the postoperative complications. There was a gradual decline in body weight in both experimental groups after surgery (P < 0.05). There was no difference in blood parameters at any time after surgery between the two methods (P > 0.05). Fecal fat content increased in the Roux-en-Y compared to the Jejunal loop interposition technique (P < 0.05). No major complications were found in radiographs and gastric emptying time was similar between the two groups (P > 0.05). CONCLUSION: Roux-en-Y and Jejunal loop interposition techniques might be considered as suitable approaches for reconstructing gastro-intestinal tract following gastrectomy in dogs. The results of this study warrant further investigation with a larger number of animals.

[Influence of different procedures of alimentary tract reconstruction after total gastrectomy for gastric cancer on the nutrition and metabolism of patients: a prospective clinical study].

OBJECTIVE: To investigate the influence of different alimentary tract reconstruction procedures after total gastrectomy for treatment of gastric cancer on nutrition and metabolism and explore an ideal reconstruction procedure. METHODS: A total of 149 patients with gastric cancer who had undergone total gastrectomy were randomly allocated into 5 groups of 30 patients (except the group HLD with 29 cases) to undergo 5 different alimentary tract reconstruction procedures: simple esophagojejunostomy using Roux-en-Y technique (RY), P pouch with Roux-en-Y reconstruction (PRY), jejunal pouch reconstruction according to Hunt-Lawrence technique (HL), jejunal pouch original interposition reconstruction modified by the authors (JOP), and Hunt-Lawrence reconstruction technique maintaining duodenal passage (HLD). Three and six months after operation, quality of life (Visick grade), PNI; body weight; and serum nutritional parameters, including albumin, (ALB), total protein (TP), transferrin (TF), hemoglobin (HB), and serum iron (SI), were evaluated. RESULTS: In comparison with those of the PRY, HL, JOP, and HLD groups, the patients of the RY group show greater weigh loss, and lower ALB, TP, and TF (all P < 0.05). The HB, SI, and TS levels in the JOP group and HLD group were significantly higher than those in the RY, PRY, and HL groups (all P < 0.05). CONCLUSION: Different procedures of alimentary tract reconstruction after total gastrectomy have great influence on the patients' nutrition at different degrees. The patients undergoing the procedures with a reservoir show higher serum nutritional parameters and better body weight. The volume of reservoir has no major clinical importance. The jejunal pouch original interposition reconstruction modified by the authors (JOP), constructing a gastric reservoir and maintaining the alimentary tract flowing through the duodenum is an ideal choice for the reconstruction after total gastrectomy.

Long-term effects of jejunal pouch added to Roux-en-Y reconstruction after total gastrectomy.

BACKGROUND: Jejunal pouch reconstruction after total gastrectomy has been demonstrated to ameliorate postgastrectomy symptoms, with the process of adaptation taking several months. In contrast to the short-term effects of pouch reconstruction, there are few reports about the long-term consequences (more than 2 years after surgery). METHODS: In this study, 22 patients with jejunal pouch (PRY group) and 12 patients without jejunal pouch (RY group) who survived for more than 2 years without any recurrence and were available for follow-up were compared. Patients in the two groups were compared 2 years after surgery in terms of postgastrectomy symptoms, and improvements in body weight and nutritional parameters. RESULTS: Eating capacity at a single meal compared with that in the pre-illness state was significantly better in the PRY group than in the RY group. The total score on the gastrointestinal symptom rating scale (GSRS) in the PRY group was less than that in the RY group (3.17 vs 5.25). The GSRS score for reflux syndrome in the PRY group was significantly better than that in the RY group. Assessment according to Cuschieri's gradings revealed that the total score in the PRY group was lower than that in the RY group (2.73 vs 5.92). Among the various symptoms examined, the incidence of dietary restriction and that of heartburn were significantly lower in the PRY group. CONCLUSION: We conclude that, 2 years after total gastrectomy, the pouch reconstruction had alleviated postgastrectomy symptoms to a greater extent than simple Roux-en-Y reconstruction, but the effectiveness could be improved. The long-term effects of pouch reconstruction should be examined more precisely with an adequate and valid scoring system for determining quality of life.

Quiste gigante de colédoco en la infancia. Informe de un caso / Gigantic choledochal cyst in infancy. Case report

Se informa el caso de una paciente de seis años de edad, atendida en el Hospital General de Zona con Medicina Familiar Núm. 1 en Pachuca Hidalgo, por una gran tumoración abdominal en el cuadrante superior derecho. Despúes de diversos exámenes de gabinete, se diagnosticó quiste gigante de colédoco tipo I de la clasificación de Alonso Lej y Todani. Esta patología debe ser tratada mediante resección total del quiste para prevenir su malignización, y la reconstrucción con hepatoyeyunoanastomosis en y de Roux. No se presentaron complicaciones y la paciente evolucionó satisfactoriamente. Se analizan en la literatura mundial la etiología, fisiopatología y pronóstico. El diagnóstico se basó en la tomografía computarizada y en el estudio patológico

Quiste de coledoco: Informe de 4 casos y revisión / Choledochal cyst: report of 4 cases and review

El qiste de colédoco es una malformación congénita de las vías biliares manifestadas por dolor abdominal.El diagnóstico generalmente serealiza por ultrasonido abdominal. El tratamiento consiste en la resección del quiste y la reconstrucción de la vía biliar por medio de una hepato-yeyunostomía en Y de Roux. El objetivo de este trabajo es el reporte de 4 casos de quiste de colédoco en niños, tratados en el Hospital Materno Infantil durante el año de 1993 en Honduras y la revisión de la literatura