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1.
J Surg Res ; 245: 330-337, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31425872

RESUMO

BACKGROUND: The goal of the present retrospective study was to elucidate the efficacy of conserving the celiac branch (CB), which can reduce the adverse reactions of Billroth-Ⅰ (B-Ⅰ) restoration after the laparoscopy-assisted distal gastrectomy (LADG). METHODS: Two hundred thirty-three patients with gastric cancer underwent B-Ⅰ reconstruction after LADG with dissection 2 lymphadenectomy from July 2005 to July 2012 and were monitored for 5 y. The patients were separated into 2 groups: celiac branch preserved (P-CB) group (n = 98) and celiac branch resected (R-CB) group (n = 135). In addition to patient information, tumor features, and surgical details, short-term and long-term variables such as bowel condition, surgical complications, and endoscopy findings were evaluated. RESULTS: In short-term efficacy, the time of first flatus and liquid ingestion were slightly shorter in the P-CB group than in the R-CB group (3.84 ± 0.74 versus 4.38 ± 0.71, P = 0.0001; 5.04 ± 1.07 versus 5.67 ± 1.10, P = 0.0001). For long-term efficacy, the incidences of chronic diarrhea, gastroparesis, residual food, bile reflux, and reflux esophagitis were less in the P-CB group compare with the R-CB group (6.1% versus 22.2%, P = 0.001; 5.1% versus 17.8%, P = 0.004; 4.1% versus 17.8%, P = 0.004; 8.2% versus 17.8%, P = 0.036; 8.2% versus 17.8%, P = 0.036). Other parameters such as postoperative ileus and gallstones had a better efficacy trend in the P-CB group but did not suggestively vary among the groups. CONCLUSIONS: The CB has an imperative part in the gastrointestinal motility, and celiac preservation mainly exerts long-term efficacy in patients who underwent B-I surgery with LADG.


Assuntos
Gastroenterostomia/métodos , Complicações Pós-Operatórias/epidemiologia , Nervo Vago , Idoso , China/epidemiologia , Feminino , Gastrectomia , Gastroenterostomia/efeitos adversos , Gastroenterostomia/mortalidade , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia
2.
Khirurgiia (Mosk) ; (12): 37-46, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825341

RESUMO

OBJECTIVE: To formulate the concept of physiological reconstruction of the digestive tract during redo gastric surgery. MATERIAL AND METHODS: There were 52 patients who underwent redo gastric surgery after previous resections, drainage and antireflux procedures in 2011-2017 at the Vishnevsky National Research Surgical Center. Redo resection of the stomach with Billroth-1 and Hofmeister reconstructions were performed in 5 (9.6%) and 1 patient (1.9%), respectively. Roux-en-Y reconstruction was performed in 4 (7.7%) patients after gastric remnant extirpation. Jejunogastroplasty was used in 30 (57.7%) patients. A segment of the transverse colon as the reconstructive material was used in 2 (3.8%) patients, left colon - in 8 (15.4%) after esophagectomy. One (1.9%) patient underwent extirpation of 'small' stomach and thoracic esophagus after previous gastric bypass. Gastric remnant was used as an isoperistaltic tube for subtotal esophagoplasty. Reconstruction was not possible in only 1 (1.9%) patient after advanced visceral resection for recurrent cancer within esophagojejunostomy due to deficit of visceral material. RESULTS: Postoperative complications were observed in 5 (9.6%) patients. Partial failure of esophagojejunostomy and duodenojejunostomy occurred in 2 (3.8%) and 1 patient (1.9%), respectively. Colon transplant necrosis was noted in 1 (1.9%) patient that required resection followed by colo- and esophagostomy nutrition. One patient died on the 1st postoperative day from progressive multiple organ failure. At the end of the study, 44 (86.2%) out of 51 patients were under follow-up. Good results were revealed in 26 (59.9%) patients, satisfactory outcomes - in 12 (27.4%) patients. Redo surgery was not effective in only 6 (13.7%) patients. CONCLUSION: Evaluation of our results demonstrates complete alleviation of pathological postoperative syndromes after gastric surgery in the majority of patients. Therefore, redo surgery with gastroplasty and restoration of duodenal passage are advisable.


Assuntos
Trato Gastrointestinal/cirurgia , Neoplasias Gástricas/cirurgia , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Duodeno/cirurgia , Gastrectomia/efeitos adversos , Gastroenterostomia/efeitos adversos , Gastroplastia , Humanos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação , Estudos Retrospectivos
4.
Medicine (Baltimore) ; 98(51): e18381, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860999

RESUMO

BACKGROUND: There is no consensus regarding which reconstruction methods are superior after laparoscopic distal gastrectomy (LDG). This study compared four reconstruction methods after LDG for gastric cancer. METHODS: Literature in EMBASE, PubMed, and the Cochrane Library was screened to compare Billroth I (B-I), Billroth II (B-II), Roux-en-Y (RY), and uncut Roux-en-Y (URY) anastomoses after LDG for gastric cancer. A Bayesian network meta-analysis (NMA) was conducted to compare these methods. RESULTS: Eighteen studies involving 4347 patients were eligible for our NMA. The operative time in RY anastomosis was longer than that in B-I and B-II anastomoses. Blood loss and risk of gastrointestinal motility dysfunction were greater with RY anastomosis than with URY or B-I anastomosis. Furthermore, URY anastomosis was superior to the other 3 reconstruction methods for preventing food residue. For remnant gastritis, RY anastomosis was significantly superior to B-I and B-II anastomoses, whereas URY anastomosis was significantly superior to B-II anastomosis. In addition, RY and URY anastomoses were better than B-I and B-II anastomoses for preventing bile reflux. CONCLUSIONS: URY anastomosis tended to be a more favorable reconstruction method after LDG due to its operative simplicity and reduced long-term complications.


Assuntos
Anastomose em-Y de Roux/métodos , Gastrectomia , Gastroenterostomia , Laparoscopia , Refluxo Biliar/prevenção & controle , Perda Sanguínea Cirúrgica , Motilidade Gastrointestinal , Humanos , Duração da Cirurgia , Neoplasias Gástricas/cirurgia
5.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(11): 1064-1069, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31770838

RESUMO

Objective: The aim of the current study is to compare the short-term clinical outcomes between Billroth-I reconstruction using an overlap method and delta-shaped anastomosis in totally laparoscopic distal gastrectomy (TLDG). Method: A retrospective cohort study was performed. The following inclusion criteria were applied: (1) Preoperative gastroscopy and CT confirmed that the tumor is located in the antrum of the stomach, and the biopsy suggested adenocarcinoma; (2) Chest, abdomen and pelvis enhanced CT showed no evidence of distant metastasis; (3) Preoperative gastric reconstruction CT or endoscopic ultrasonography suggested that the clinical stage of the tumor is stage I-III. (4) During the operation, the tumor position was confirmed to be located in the antrum of the stomach by nanocarbon injection or gastroscope; (5) Complete laparoscopic radical gastrectomy for distal gastrectomy, and the gastrointestinal reconstruction was performed by delta-shaped anastomosis or overlap anastomosis. And the following exclusion criteria were applied: (1) History of gastric surgery; (2) Patients who cannot tolerate laparoscopic surgery because of comorbidities. Finally, data on 43 consecutive patients who underwent TLDG with Billroth-I reconstruction between January 2016 and November 2018 in Peking Union Medical College Hospital were retrospectively reviewed. Patients were divided into those who underwent Billroth-I reconstruction using an overlap method (n=20) or using delta-shaped anastomosis (n=23). The demographic and clinical characteristics and perioperative data of the two groups were analyzed. Measurement data that conformed to the normal distribution were expressed as the mean ± s, and differences between groups were compared using Student's t-test; comparisons between the counting data groups were performed using the χ(2) test or the continuously corrected χ(2) test. Results: The demographic and clinical characteristics were similar between the delta-shaped group and the overlap group (P>0.05). There was no significant difference between groups regarding operation time [(185.9±22.8) minutes vs. (184.0±25.8) minutes, t=0.260, P=0.796], blood loss [(50.9±36.0) ml vs. (47.0±30.8) ml, t=0.375, P=0.709], number of stapler reloads used for anastomosis (5.1±0.3 vs. 5.2±0.6, t=-0.465, P=0.651), time to flatus [(3.3±0.9) days vs. (3.6±0.9) days, t=-1.067, P=0.292) and postoperative hospitalization [(8.8±3.1) days vs. (10.4±3.8) days,t=-1.494, P=0.143]. As for the delta-shaped group and the overlap group, the anastomotic leakage rate was 4.3% (1/23) and 0 (χ(2)=0.000, P=1.000), respectively. The incidence of anastomotic bleeding was 4.3% (1/23) and 5.0% (1/20) (χ(2)=0.000, P=1.000), while the incidence of intra-abdominal hemorrhage was 4.3% (1/23) and 0 (χ(2)=0.000, P=1.000). The incidence of gastric emptying disorders was 4.3% (1/23) and 30.0% (6/20), respectively (χ(2)=3.454, P=0.063). All complications were cured after conservative treatment or symptomatic treatment. Conclusion: The overlap method for Billroth-I reconstruction is safe and feasible.


Assuntos
Gastroenterostomia/métodos , Neoplasias Gástricas/cirurgia , Gastrectomia , Humanos , Laparoscopia , Estudos Retrospectivos , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(41): e17543, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593134

RESUMO

This study aims to investigate the adaptation process of the alimentary tract after distal gastrectomy and understand the impact of remnant stomach volume (RSV) on diet recovery.One year after gastrectomy, although patients' oral intake had increased, the RSV was decreased and small bowel motility was enhanced. Patients with a larger RSV showed no additional benefits regarding nutritional outcomes.We prospectively enrolled patients who underwent distal gastrectomy with Billroth II reconstruction to treat gastric cancer at a tertiary hospital cancer center between September 2009 and February 2012. Demographic data, diet questionnaires, computed tomography (CT), and contrast fluoroscopy findings were collected. Patients were divided into 2 groups according to the RSV calculated using CT gastric volume measurements (large vs small). Dietary habits and nutritional status were compared between the groups.Seventy-eight patients were enrolled. Diet volume recovered to 90% of baseline by the 36 postoperative month, and RSV was 70% of baseline at 6 months after surgery and gradually decreased over time. One year after surgery, small bowel transit time was 75% compared to the 1st postoperative month (P < .05); however, transit time in the esophagus and remnant stomach showed no change in any studied interval. Compared to patients with a small RSV, those with a large RSV showed no differences in diet volume, habits, or other nutritional benefits (P > .05).Diet recovery for distal gastrectomy patients was achieved by increased small bowel motility. The size of the remnant stomach showed no positive impact on nutritional outcomes.


Assuntos
Dieta/estatística & dados numéricos , Gastrectomia/métodos , Coto Gástrico/diagnóstico por imagem , Gastroenterostomia/métodos , Neoplasias Gástricas/cirurgia , Adaptação Fisiológica , Idoso , Feminino , Motilidade Gastrointestinal/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Período Pós-Operatório , Estudos Prospectivos , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X
7.
World J Gastroenterol ; 25(36): 5494-5504, 2019 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-31576095

RESUMO

BACKGROUND: Laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) was known to have benefits of function-preserving surgery compared to laparoscopy-assisted distal gastrectomy (LADG). However, in clinical settings, delayed gastric emptying and esophageal reflux following LAPPG can be serious issues, making surgeons reluctant to perform LAPPG. It is unclear that LAPPG had better long-term functional outcomes and quality of life compared to LADG. AIM: To evaluate the long-term functional outcomes and patient-reported quality of life of LAPPG compared to those of LADG. METHODS: We reviewed the clinicopathological data of 195 patients who underwent LADG with Billroth II anastomosis and 101 patients who underwent LAPPG for cT1N0 gastric cancer in the middle third of the stomach between 2012 and 2015. Postoperative complications, nutritional parameters, and survey results of the European Organization for Research and Treatment of Cancer Questionnaire C30 and STO22 questionnaire were compared between the two groups. RESULTS: The serum hemoglobin level was significantly higher in the LAPPG group than in the LADG group (P < 0.001). In the endoscopic findings, incidence of bile reflux was lower (P < 0.001); however, the incidence of residual food was higher in the LAPPG group than in the LADG group (P < 0.001). Regarding the quality of life score, the LAPPG group had a better physical functioning score (86.7 vs 90.0, P = 0.032) but also greater pain and reflux when compared to the LADG group [8.3 vs 16.7 in pain, 11.1 (interquartile range, 0, 22.2) vs 11.1 (interquartile range, 11.1, 33.3) in reflux, P = 0.034 and 0.001, respectively]. CONCLUSION: LAPPG is beneficial to recovery of anemia and to bile reflux, however, it might be unfavorable in terms of pain and reflux symptoms compared to LADG with Billroth II anastomosis.


Assuntos
Gastrectomia/efeitos adversos , Refluxo Gastroesofágico/epidemiologia , Laparoscopia/métodos , Tratamentos com Preservação do Órgão/efeitos adversos , Dor Pós-Operatória/epidemiologia , Piloro/cirurgia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Feminino , Gastrectomia/métodos , Gastroenterostomia/efeitos adversos , Gastroenterostomia/métodos , Refluxo Gastroesofágico/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tratamentos com Preservação do Órgão/métodos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Qualidade de Vida , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Resultado do Tratamento
8.
Gan To Kagaku Ryoho ; 46(10): 1626-1628, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31631156

RESUMO

This is a case of a 76-year-old man who had no significant past medical or family history. In the current medical history, in November 2017, upper gastrointestinal endoscopy showed a semicircular protruding lesion in the posterior wall of the gastric antrum, and gastric cancer was diagnosed following biopsy. Endoscopic submucosal dissection(ESD)was performed in the same year for the treatment of gastric cancer(cT1aN0M0). Pathological findings after ESD treatment showed invasion into the submucosa requiring non-curative resection. For this reason, laparoscopic pylorus side gastrectomy(D1 dissection)and Billroth Ⅰ reconstruction were performed as additional procedures in March 2018. The patient was discharged on the 10th postoperative day and was followed-up on an outpatient basis. On the postoperative day 14, he was re-admitted with complaints of upper abdominal pain and exacerbation of inflammation. Medical treatment, such as antibiotic administration was followed, however, a high degree of inflammatory response, renal dysfunction, and occult blood in urine were observed. Because of suspicion of vasculitis-related nephritis, the case was diagnosed as anti-GBM antibody type rapid progressive nephritis. We came across a case of rapidly progressive glomerulonephritis after laparoscopic pylorus side gastrectomy performed for early gastric cancer, and hence, We will review the related literature.


Assuntos
Glomerulonefrite , Laparoscopia , Neoplasias Gástricas , Idoso , Gastrectomia , Gastroenterostomia , Humanos , Masculino
9.
Khirurgiia (Mosk) ; (8): 91-94, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31464282

RESUMO

A successful administration of NPWT-therapy combined with Reamberin infusion for gastroenterostomy failure after stomach resection is reported in the article. It was noted that antioxidant/antihypoxic drug Reamberin combined with NPWT-therapy has a positive metabolic effect and results more active and rapid healing of the wounds. The absence of adverse effects of the drug allows us to recommend its inclusion into complex treatment of patients with this pathology.


Assuntos
Antioxidantes/uso terapêutico , Gastrectomia/métodos , Gastroenterostomia/efeitos adversos , Fármacos Gastrointestinais/uso terapêutico , Meglumina/análogos & derivados , Tratamento de Ferimentos com Pressão Negativa , Estômago/cirurgia , Succinatos/uso terapêutico , Gastrectomia/efeitos adversos , Humanos , Meglumina/uso terapêutico , Cicatrização/efeitos dos fármacos
10.
World J Gastroenterol ; 25(24): 3091-3107, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31293344

RESUMO

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy has been considered a challenging procedure due to the surgically altered gastrointestinal anatomy. However, there has been a paucity of comparative studies regarding ERCP in Billroth II gastrectomy cases because of procedure-related morbidity and mortality and practical and ethical limitations. This systematic and comprehensive review was performed to obtain a recent perspective on ERCP in Billroth II gastrectomy patients. AIM: To systematically review the literature regarding ERCP in Billroth II gastrectomy patients. METHODS: A systematic review was performed on the literature published between May 1975 and January 2019. The following electronic databases were searched: PubMed, EMBASE, and Cochrane Library. The outcomes of successful afferent loop intubation and successful selective cannulation and occurrence of adverse events were assessed. RESULTS: A total of 43 studies involving 2669 patients were included. The study designs were 36 (83.7%) retrospective cohort studies, 4 (9.3%) retrospective comparative studies, 2 (4.7%) prospective comparative studies, and 1 (2.3%) prospective cohort study. Of a total of 2669 patients, there were 1432 cases (55.6%) of side-viewing endoscopy, 664 (25.8%) cases of forward-viewing endoscopy, 171 (6.6%) cases of balloon-assisted enteroscopy, 169 (6.6%) cases of anterior oblique-viewing endoscopy, 64 (2.5%) cases of dual-lumen endoscopy, 31 (1.2%) cases of colonoscopy, and 14 (0.5%) cases of multiple bending endoscopy. The overall success rate of afferent loop intubation was 91.3% (2437/2669), and the overall success rate of selective cannulation was 87.9% (2346/2437). A total of 195 cases (7.3%) of adverse events occurred. The success rates of afferent loop intubation and the selective cannulation rate for each type of endoscopy were as follows: side-viewing endoscopy 98.2% and 95.3%; forward-viewing endoscopy 97.4% and 95.2%; balloon-assisted enteroscopy 95.4% and 97.5%; oblique-viewing endoscopy 94.1% and 97.5%; and dual-lumen endoscopy 82.8% and 100%, respectively. The rate of bowel perforation was slightly higher in side-viewing endoscopy (3.6%) and balloon-assisted enteroscopy (4.1%) compared with forward-viewing endoscopy (1.7%) and anterior oblique-viewing endoscopy (1.2%). Mortality only occurred in side-viewing endoscopy (n = 9, 0.6%). CONCLUSION: The performance of ERCP in the Billroth II gastrectomy population has been improving with choice of various type of endoscope and sphincter management. More comparative studies are needed to determine the optimal strategy to perform safe and effective ERCP in Billroth II gastrectomy patients.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Endoscópios , Gastrectomia/efeitos adversos , Gastroenterostomia/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Gastrectomia/métodos , Gastroenterostomia/métodos , Humanos , Resultado do Tratamento
11.
Rev Gastroenterol Peru ; 39(2): 187-192, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31333239

RESUMO

Anastomotic leakages at the gastrojejunostomy site are difficult to repair, due to complex gastrointestinal anatomy. This is the first study reporting clinical use of rectus abdominis muscle (RAM) flap for repair of gastrojejunostomy leakage. A patient with leakage of gastrojejunostomy after distal gastrectomy with Billrroth II anastomosis for gastric cancer underwent repair using left RAM flap, based on superior epigastric artery. Rectus abdominis muscle flap, after being harvested was then anchored to the edges of the leak of gastrojejunostomy with few interrupted 2-0 vicryl sutures. Gastrojejunostomy leak sealed in the two cases. Rectus abdominis muscle flap for closure of gastrointestinal defect is a simple, technically easy and dependable procedure, which can be performed, quickly in critically ill patients. It can be used for repair of a large gastrointestinal defect with friable edges when omentum is not available or when other conventional methods are impractical.


Assuntos
Fístula Anastomótica/cirurgia , Gastrectomia/métodos , Derivação Gástrica , Neoplasias Gástricas/cirurgia , Retalhos Cirúrgicos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Gastroenterostomia , Humanos , Pessoa de Meia-Idade , Reto do Abdome/transplante
12.
Trials ; 20(1): 428, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31300019

RESUMO

BACKGROUND: Gastric cancer is the fourth most common malignant disease worldwide, with lower one-third gastric cancer the most common type. Distal gastrectomy with D2 lymph node dissection was recommended as a standard surgery for distal gastric cancer patients. However, some controversy remains about the anastomosis of the residual stomach and the intestine. The objectives of this trial are to test the hypothesis that uncut Roux-en-Y anastomosis can reduce postoperative complications and improve nutritional status more effectively than Billroth II anastomosis in gastric cancer patients after D2 gastrectomy. METHODS/DESIGN: This multi-center, prospective, phase III, randomized controlled trial will compare the efficacy of uncut Roux-en-Y anastomosis versus Billroth II anastomosis in phase I-III patients with initial treatment of radical distal gastrectomy. Patients will be randomized to undergo either the intervention (uncut Roux-en-Y anastomosis) or the control (Billroth II anastomosis). We will recruit 832 patients who meet the trial eligibility criteria and will follow the patients after surgery to observe postoperative complications and nutrition status for 5 years. The primary assessment indices of the study are reflux gastritis, esophagitis, bile regurgitation, and anastomotic ulcer. The secondary assessment indices are nutritional status, quality of life, perioperative complications, overall survival rate, and others. When the number of cases reaches 400, an interim analysis will be performed to identify any evidence of definite superiority of the experimental intervention. DISCUSSION: We aim to test the hypothesis that uncut Roux-en-Y anastomosis can reduce postoperative complications and improve nutritional status more than Billroth II anastomosis in gastric cancer patients after D2 gastrectomy. The results of the trial will contribute to the best evidence on which to base the reconstruction of distal gastrectomy. TRIAL REGISTRATION: Chinese Southern Gastric Cancer Conference CSGC002 Trial. ClinicalTrials.gov, NCT02763878 . Registered on 5 May 2016.


Assuntos
Anastomose em-Y de Roux/efeitos adversos , Gastrectomia , Gastroenterostomia/efeitos adversos , Estado Nutricional , Complicações Pós-Operatórias/etiologia , Neoplasias Gástricas/cirurgia , Adolescente , Adulto , Idoso , China , Ensaios Clínicos Fase III como Assunto , Estudos de Equivalência como Asunto , Feminino , Gastrectomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Neoplasias Gástricas/patologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
13.
Anticancer Res ; 39(6): 3227-3230, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177172

RESUMO

BACKGROUND: We advocated the usefulness of pylorus-reconstruction gastrectomy (PRG) to improve quality of life following surgery for gastric cancer. The current study assessed gastric emptying following PRG in comparison with those who underwent conventional Billroth-I (B-I) reconstruction and in healthy controls using a 13C breath test. PATIENTS AND METHODS: The study group consisted of 24 patients who underwent PRG from September 20, 2007 to July 26, 2012 at the Department of Surgery at Daisan Hospital (affiliated with The Jikei University School of Medicine). These patients underwent the 'standard' version of a gastric-emptying study using a 13C breath test at 20.5±11.8 months after surgery. During the study, the half gastric-emptying time (T1/2) and gastric retention at 5 min after ingestion (RR5) were measured. The data of the PRG group were compared to those for 26 patients who underwent conventional B-I reconstruction and with a group consisting of 20 healthy controls. RESULTS: RR5 was 69.6±21.8% in the patients who underwent PRG, 45.3±28.6% in those who underwent B-I reconstruction, and 93.7±5.7% in healthy controls. T1/2 was 17.0±13.0 min in patients who underwent PRG, 5.9±4.0 min in those who underwent B-I reconstruction, and 23.3±4.9 min in healthy controls. Gastric emptying was delayed in patients who underwent PRG compared to those who underwent B-I reconstruction (RR5: p<0.0014, T1/2: p<0.0002), and was comparable to that of healthy controls. CONCLUSION: Gastric emptying improved significantly after PRG compared to B-I reconstruction, and approached that of healthy controls.


Assuntos
Testes Respiratórios , Gastrectomia/métodos , Esvaziamento Gástrico , Gastroenterostomia/métodos , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Gastrectomia/efeitos adversos , Gastroenterostomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Qualidade de Vida , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
14.
Khirurgiia (Mosk) ; (5): 77-81, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31169824

RESUMO

Treatment of complicated giant duodenal ulcers is one of the most difficult problems in abdominal surgery. Simultaneous course of diabetes mellitus and giant duodenal ulcer has clinical features and requires correction of the treatment. It is presented case report that may be useful regarding accumulation of knowledge about comorbid course of these pathologies. The patient 58-year old was urgently delivered with signs of gastrointestinal bleeding, ulcerative anamnesis for 15 years, diabetes mellitus type 2 for 8 years. Gastroduodenoscopy revealed chronic giant (2.5×3.5 cm) duodenal ulcer complicated by bleeding and subcompensated pyloric stenosis. Endoscopic hemostasis included drug injection and argon-plasma coagulation. Recurrent bleeding occurred after 22 hours. It was performed Billroth II procedure with resection of 2/3 of the stomach and manual formation of 'difficult' duodenal stump. Cicatricial ring was used as a frame for the stump. Postoperative period was uneventful, patient was discharged after 14 days. This clinical case demonstrates the need for more active surgical strategy in patients with diabetes mellitus and reliability of the proposed method of 'difficult' stump forming.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Úlcera Duodenal/cirurgia , Úlcera Péptica Hemorrágica/cirurgia , Estenose Pilórica/cirurgia , Cicatriz/etiologia , Cicatriz/cirurgia , Úlcera Duodenal/complicações , Úlcera Duodenal/diagnóstico , Duodeno/patologia , Duodeno/cirurgia , Gastroenterostomia , Humanos , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/diagnóstico , Úlcera Péptica Hemorrágica/etiologia , Estenose Pilórica/diagnóstico , Estenose Pilórica/etiologia , Reprodutibilidade dos Testes
16.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(5): 441-445, 2019 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-31104429

RESUMO

Objective: To investigate the application value of Overlap anastomosis in Billroth I digestive tract reconstruction after laparoscopic distal gastrectomy in gastric cancer. Methods: Clinical data of 68 stage T1-2 gastric cancer patients undergoing laparoscopic distal gastrectomy for D2 radical gastrectomy from January 2015 to January 2016 at China Japan Union Hospital of Jilin University were retrospectively analyzed. Inclusion criteria: (1) no distant metastasis of gastric cancer confirmed by gastroscopy and pathology before surgery; (2) T1-2 tumor with diameter <3 cm; (3) the lesion locating in the antrum of the stomach with distance >1 cm from the pylorus, and no invasion into middle area; (4) R0 resection confirmed by postoperative pathology; (5) no history of abdominal surgery. Among 68 cases,23 cases were in Overlap anastomosis group and 45 cases in Billroth I anastomosis group. D2 lymph node dissection and distal gastrectomy were performed in both groups. In the Overlap anastomosis group, the duodenum and stomach were severed by a linear stapler under endoscopy, and the residual gastric curve anastomotic opening was selected. According to the tension between the duodenum and the remnant stomach, the anastomotic opening was selected at the upper edge of the remnant duodenum, and the anastomosis between the posterior wall of the remnant stomach and the upper wall of the duodenum was completed by placing the stapler under endoscopy. Then the common opening was closed and the remnant duodenum was resected. In the traditional Billroth I anastomosis group, pneumoperitoneum was discontinued after amputation of the duodenum under laparoscopy. The median incision of the upper abdomen was 9-12 cm. The distal stomach was pulled out to complete the excision of specimens, the extraction of specimens and Billroth I digestive tract reconstruction. The intraoperative and postoperative conditions of the two groups were compared with student t test (continuous variable) and chi-square test (categorica variable). Results: Of the 68 patients,39 were males and 29 were females,with age of (65.5±10.2)(51 to 77)years. Differences in baseline data between Overlap group and Billroth I group were not statistically significant (all P>0.05). Laparoscopic surgery was successfully performed in both groups without conversion to open operation. As compared with the Billroth I group, the Overlap group had significantly shorter operation time [(149.8±10.1) minutes vs. (169.8±15.3) minutes, t=5.658,P=0.008], shorter anastomotic time of digestive tract reconstruction [(31.2±3.8) minutes vs. (36.3±3.3) minutes, t=3.389, P=0.003] and shorter abdominal incision length [(4.5±0.9) cm vs.(11.0±2.3) cm, t=13.244,P=0.004]. There were no significant differences between two groups in intraoperative blood loss [(92.9±22.4) ml vs. (87.0±7.3) ml,t=1.186,P=0.366], number of lymph node dissected (28.4±5.7 vs. 27.3±5.2, t=0.838, P=0.383), postoperative flatus time [(4.4±2.1) days vs.(4.2±1.8) days, t=0.391, P=0.563], morbidity of postoperative complication [4.3%(1/23) vs. 6.7%(3/45), χ2=0.148,P=0.701]. All the patients were followed up for 28±10 (10-46) months. There were no long-term complications, recurrence or death in two groups. Conclusion: Overlap anastomosis in Billroth I digestive tract reconstruction after laparoscopic distal gastrectomy is safe and effective, and can reduce the anastomosis time.


Assuntos
Gastrectomia/métodos , Gastroenterostomia/métodos , Neoplasias Gástricas/cirurgia , Idoso , Anastomose Cirúrgica/métodos , Feminino , Humanos , Laparoscopia , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Neoplasias Gástricas/patologia
17.
BMC Surg ; 19(1): 48, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088424

RESUMO

BACKGROUND: Performance of gastrectomy in gastric cancer patients can lead to an increased incidence of cholecystolithiasis (CL) and a higher morbidity rate. However, the value of prophylactic cholecystectomy performed during gastric cancer surgery is still being debated. METHODS: We carried out a retrospective study on patients with gastric cancer who underwent subtotal or total gastrectomy, with preservation of the gallbladder or simultaneous cholecystectomy from January 2010 to March 2018. RESULTS: Cholecystolithiasis occurred in 152 of 1691 (8.98%) patients after gastric cancer surgery, with 45 (2.67%) patients undergoing subsequent cholecystectomy. Postoperative body mass index (BMI) decrease > 5% in 3 months was an independent risk factor for cholecystolithiasis [BMI decrease > 5%/≤5%: OR (95%CI): 1.812 (1.225-2.681), p = 0.003). Gastrectomy method and diabetes mellitus were independent risk factors for both cholecystolithiasis [gastrectomy method (no-Billroth I/Billroth I): OR (95%CI): 1.801 (1.097-2.959), p = 0.002; diabetes mellitus (yes/no): OR (95%CI): 1.544 (1.030-2.316), p = 0.036] and subsequent cholecystectomy [gastrectomy method (no-Billroth I/Billroth I): OR (95%CI): 5.432 (1.309-22.539), p = 0.020; diabetes mellitus (yes/no): OR (95%CI): 2.136 (1.106-4.125), p = 0.024]. Simultaneous cholecystectomy was performed in 62 of 1753 (3.5%) patients. The mortality and morbidity rates did not differ significantly between the combined surgery group and the gastrectomy only group (8.1% vs. 8.9 and 1.6% vs. 2.2%, respectively, p > 0.05). CONCLUSIONS: Prophylactic cholecystectomy may be necessary in gastric cancer patients without Billroth I gastrectomy and with diabetes mellitus. Simultaneous cholecystectomy during gastric cancer surgery does not increase the postoperative mortality and morbidity rates.


Assuntos
Colecistectomia , Colecistolitíase/prevenção & controle , Gastrectomia , Procedimentos Cirúrgicos Profiláticos , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Complicações do Diabetes , Feminino , Gastrectomia/métodos , Gastroenterostomia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco
18.
Khirurgiia (Mosk) ; (4): 94-99, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31120455

RESUMO

AIM: To obtain the most reliable information about surgical treatment of ulcerative pyloroduodenal stenosis based on the methodology of evidence-based medicine. MATERIAL AND METHODS: Searching platforms were elibrary, Cochrane Library and PubMed database. The probability of major systematic errors in randomized controlled trials (RCTs) was evaluated. RESULTS: Systematic review included 20 RCTs for the period 1968-2009 with overall sample of 1794 patients. Evaluation of external validity allows to generalize the results of these studies to the entire population of patients with ulcerative pyloroduodenal stenosis. Assessment of internal validity based on the number of systematic errors showed that 7 (35%) of 20 of RCTs corresponded to the highest level of evidence (level 1), 13 (65%) of 20 had systematic errors and were downgraded in the rating (level 1-). Significant heterogeneity of RCTs impedes metaanalysis. Conclusions and practical recommendations for the treatment of ulcerative pyloroduodenal stenosis are formed according to the results of individual RCTs. CONCLUSION: Selective vagotomy may be performed for functional stenosis. In case of organic stenosis, truncal vagotomy should be combined with drainage surgery (pyloroplasty, gastroenterostomy) or Roux/Billroth-1 antrectomy. Treatment of decompensated stenosis within evidence-based medicine is unclear. We have not identified target researches with evidence level 1 for this form of stenosis.


Assuntos
Úlcera Péptica/cirurgia , Estenose Pilórica/cirurgia , Duodenopatias/cirurgia , Gastroenterostomia , Humanos , Antro Pilórico/cirurgia , Piloromiotomia , Ensaios Clínicos Controlados Aleatórios como Assunto , Gastropatias/cirurgia , Vagotomia
19.
Acta Cir Bras ; 34(3): e201900308, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30892394

RESUMO

PURPOSE: To create a checklist to evaluate the performance and systematize the gastroenterostomy simulated training. METHODS: Experimental longitudinal study of a quantitative character. The sample consisted of twelve general surgery residents. The training was divided into 5 sessions and consisted of participation in 20 gastroenterostomys in synthetic organs. The training was accompanied by an experienced surgeon who was responsible for the feedback and the anastomoses evaluation. The anastomoses evaluated were the first, fourth, sixth, eighth and tenth. A 10 item checklist and the time to evaluate performance were used. RESULTS: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The correlation index of 0.545 and 0,295 showed a high linear correlation between time variables and Checklist. The average Checklist score went from 6.8 to 9 points. CONCLUSION: The proposed checklist can be used to evaluate the performance and systematization of a simulated training aimed at configuring a gastroenterostomy.


Assuntos
Lista de Checagem , Gastroenterostomia/educação , Internato e Residência , Treinamento por Simulação/métodos , Competência Clínica , Humanos , Estudos Longitudinais , Modelos Anatômicos
20.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(3): 273-278, 2019 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-30919381

RESUMO

OBJECTIVE: To compare the safety of Billroth I and Billroth II reconstruction in distal gastrectomy for gastric cancer and short-term endoscopic findings. METHODS: A retrospective cohort study was carried out. Clinical data of gastric adenocarcinoma patients who received distal subtotal gastrectomy with Billroth I or Billroth II reconstruction at Department 4 of Gastrointestinal Surgery, Peking University Cancer Hospital from January 2013 to July 2017 were collected retrospectively. Patients with stage IV gastric cancer, emergent operation, preoperative chemotherapy, combined organ resection and other malignancies were excluded. A total of 277 patients were enrolled in the study with 143 patients in the Billroth I group and 134 patients in the Billroth II group. The intra-operative conditions, postoperative early recovery, postoperative complications, and postoperative 1-year endoscopic findings were compared between the two groups. The normal distribution variables were analyzed by t test; the non-normal distribution variables were analyzed by Mann-Whitney U test; sort variables were compared between groups using the χ² test or Fisher's exact test. RESULTS: In the Billroth I group, 93 (65.0%) cases were male, mean age was (58.1±10.9) years and body mass index was (23.3±3.2) kg/m2. In the Billroth II group, 94 (70.1%) cases were male, mean age was (58.3±9.5) years and body mass index was (23.7±2.9) kg/m2. There were no significant differences in baseline data between in the two groups (all P>0.05). As compared to the Billroth I group, the Billroth II group had significantly longer operation time [mean (230.7±44.6) minutes vs. (210.3±41.4) minutes, t=3.935, P<0.001], significantly shorter time to first diet (median 7.0 vs. 8.0 days, Z=3.376, P=0.001), to first abdominal drainage tube removing (median 8.0 vs. 8.0 days, Z=2.176, P=0.030) and significantly shorter postoperative hospital stay (median 9.0 vs. 10.0 days, Z=3.616, P<0.001). There were no significant differences between two groups in proportion of laparoscopic surgery, intra-operative blood loss, number of harvested lymph nodes and the first flatus time (all P>0.05). In the Billroth I group, 1 case developed anastomotic bleeding, 3 cases anastomotic leakage, 4 cases emptying disorder, 4 cases peritoneal cavity infection, and all of them healed after conservative treatment. In the Billroth II group, 1 case developed anastomotic bleeding, 1 case peritoneal cavity bleeding, 3 cases emptying disorder, 3 cases peritoneal cavity infection, and all of them healed after conservative treatment, while 1 case developed postoperative duodenal stump leakage and underwent a second operation. Morbidity of postoperative complication was 8.4% (12/143) and 6.7% (9/134) in the Billroth I group and Billroth II group respectively (χ²=0.277, P=0.599) without statistically significant difference. Postoperative one-year endoscopy was performed in 78 cases of the Billroth I group and 57 cases of the Billroth II group. Endoscopic findings revealed that ratio of food retention [21.8% (17/78) vs. 33.3% (19/57), χ²= 2.242, P=0.134], ratio of residual gastritis [48.7% (38/78) vs. 47.4% (27/57), χ²=0.024, P=0.877] and incidence of bile reflux [12.8% (10/78) vs. 10.5% (6/57), χ²=0.166, P=0.684] were not significantly different between two groups. CONCLUSIONS: For distal gastrectomy, Billroth I reconstruction is easier to operate, while Billroth II reconstruction presents faster recovery of gastrointestinal function and shorter hospital stay. The morbidity of postoperative complication and short-term endoscopic findings between two groups are comparable.


Assuntos
Neoplasias Gástricas , Idoso , Feminino , Gastrectomia , Gastroenterostomia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia
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