[Alkaline gastritis. Gastric reoperations]. / Gastritis alcalina. Reoperaciones gástricas.

The authors present 23 cases (1.6%) of reoperated patients with alkaline gastritis syndrome at Dr. Bonorino Udaondo National Gastroenterology Hospital. Over 1400 surgical operations performed in order to treat the gastroduodenal ulcer disease; 19 patients showed an evident syndrome of alkaline gastritis and the rest of cases had a mixed syndrome, because of another syndromes. The initial operation was a gastric resection Billroth II type in 22 cases and the rest are had a vagotomy with a gastroenterostomy. In all the cases, clinical, radiological, laboratory, endoscopy and histopathology aspects as well as Kay and Hollander test were studied. The modified surgical operations were: Soupault-Bucaille with isoperistaltic loop (7 cases), with anisoperistaltic loop Poth type (1 case), reoperations with the Y en Roux technique (14 cases), desgastroenterostomy, closing of the jejunal and gastric drainage and pyloroplasty (1 case). It was fulfilled with a vagotomy. The 50% of the cases have to 8 years after the operation; another were reexamined at 100 and 15 years being without symptoms.

[An antiperistaltic duodenojejunal pouch in the reconstruction of digestive transit after subtotal and total gastrectomy and in the postgastrectomy syndrome. Results]. / Bolsa duodenojejunal antiperistáltica na reconstrução do trânsito digestivo após gastrectomia subtotal, total e na síndrome pós-gastrectomia. Resultados.

The author presents the results of a new surgical technique for the reconstruction of the gastrointestinal tract after gastrectomy. It was utilized in 36 patients (ten with total, 16 with subtotal and seven with minimal radical gastrectomy and also three cases of post-gastrectomy syndrome). The initial methodology, using the lost tie (group striction (GST)) to the duodenojejunal reservoir was not successful since it showed recanalization and consequent refluxing esophagitis (55,5%). For that reason, we changed to a complete section of the intestinal loop (group section (GS)). The follow up period ranged from one to 49 months. The following complications were observed: incisional hernia, one case (GST); early postoperative period death (19th day), one case (GS); dumping syndrome, one case (GST); bilious vomiting, two cases (GS); diarrhea, four cases (one GST and three GS). Clinically, in the late follow up of patients without recurrency of neoplasia, 17 of them have gained weight, four have lost weight and two were unaltered. Laboratory tests such as amilasemia, hematologic, proteins and glycemia were favorable to the method. Postoperative function, studied roentgenologically, showed that the average time emptying of the remmant stomach was 115 minutes in the subtotal resections and 82 minutes in total resections. The filling of the reservoir by the barium solution ranged from 40 to 60%; this variation depended on whether the duodenum was in peristalsis or antiperistalsis. Late death occurred in 13 patients, none because of the proposed technique.

[Antiperistaltic duodenojejunal pouch in the reconstruction of digestive transit after subtotal, total gastrectomy and in the postgastrectomy syndrome. Technic]. / Bolsa duodenojejunal antiperistáltica na reconstrucão do trânsito digestivo após gastrectomia subtotal, total e na síndrome pós-gastrectomia. Técnica.

A new technic for reconstruction of the digestive tract after total and subtotal gastrectomy in patients with BII postgastrectomy syndrome is proposed. This technic is based on: 1) the to-and-from motion of the barium inside the duodenal arch, and 2) the duodenogastric reflux, both observed in X-ray examinations in normal and in patients bearing gastroduodenal ulcers. The advantage of this technic is to associate the inverted Y en Roux with an interposition of a small bowel segment, besides a reservoir with dynamic function which is obtained using the duodenal arch, as well as 10 cm of jejunum, where the ingested food is mixed with the digestive secretions and is eliminated with antiperistalsis, without stasis. From 1977 to 1983, 36 patients were operated on with the above mentioned technic. Ten of them were admitted to total gastrectomy, 16 to subtotal gastrectomy, 7 to minimal radical gastrectomy and three to postgastrectomy syndrome.

[Alkaline reflux gastritis. Surgical treatment]. / Gastrite alcalina de refluxo. Tratamento cirúrgico.

The authors present the results of 35 patients with alcaline gastritis submitted to truncal vagotomy and jejunostomy by Roux in technic. Preoperative diagnosis was founded in clinical symptoms and endoscopy with histopathology. In a follow-up of 84,8% of the patients, clinical results were excellent or good in 92,8%, showing relief of pain and vomits, gastric endoscopy almost normal and on histopathology.