1
|
Duan P, Sun L, Kou K, Li XR, Zhang P. Surgical techniques to prevent delayed gastric emptying after pancreaticoduodenectomy. Hepatobiliary Pancreat Dis Int 2024; 23:449-457. [PMID: 37980179 DOI: 10.1016/j.hbpd.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 10/31/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Delayed gastric emptying (DGE) is one of the most common complications after pancreaticoduodenectomy (PD). DGE represents impaired gastric motility without significant mechanical obstruction and is associated with an increased length of hospital stay, increased healthcare costs, and a high readmission rate. We reviewed published studies on various technical modifications to reduce the incidence of DGE. DATA SOURCES Studies were identified by searching PubMed for relevant articles published up to December 2022. The following search terms were used: "pancreaticoduodenectomy", "pancreaticojejunostomy", "pancreaticogastrostomy", "gastric emptying", "gastroparesis" and "postoperative complications". The search was limited to English publications. Additional articles were identified by a manual search of references from key articles. RESULTS In recent years, various surgical procedures and techniques have been explored to reduce the incidence of DGE. Pyloric resection, Billroth II reconstruction, Braun's enteroenterostomy, and antecolic reconstruction may be associated with a decreased incidence of DGE, but more high-powered studies are needed in the future. Neither laparoscopic nor robotic surgery has demonstrated superiority in preventing DGE, and the use of staplers is controversial regarding whether they can reduce the incidence of DGE. CONCLUSIONS Despite many innovations in surgical techniques, there is no surgical procedure that is superior to others to reduce DGE. Further larger prospective randomized studies are needed.
Collapse
Affiliation(s)
- Peng Duan
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun 130021, China
| | - Lu Sun
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun 130021, China
| | - Kai Kou
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun 130021, China
| | - Xin-Rui Li
- Department of Dental Implantology, Hospital of Stomatology, Jilin University, Changchun 130021, China
| | - Ping Zhang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun 130021, China.
| |
Collapse
|
2
|
Meng SJ, Fan MQ, Qian JS, Zhang JW, Xu HH, Zheng Y, Zhao WQ, Shan LT, Huang JF. An Innovative Model of ISS-Based Multiple Fractures and Gastrointestinal Dysfunction Related to c-Kit Protein Expression on Interstitial Cells of Cajal. Orthop Surg 2023; 15:1325-1332. [PMID: 36919913 PMCID: PMC10157708 DOI: 10.1111/os.13599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/01/2022] [Accepted: 10/24/2022] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE Gastrointestinal dysfunction seriously affects the prognosis and quality of life of patients with multiple fractures. However, experimental evidence of this relationship is lacking. Here we describe a newly developed mouse model of postoperative gastrointestinal dysfunction after multiple fractures. METHODS Trauma severity was assessed using the injury severity score (ISS). Based on the ISS, a multiple fracture model was established in mice as follows: limb fractures with pelvic fractures and multiple rib fractures; limb fractures with multiple rib fractures; closed fracture of both forelegs with pelvic fracture and rib fractures; closed limb fractures; limb fracture with pelvic fracture; spinal fractures; hind leg fractures with pelvic fractures; pelvic fracture with multiple rib fractures; closed fracture of both fore legs with pelvic fracture; and closed fracture of both fore legs with multiple rib fractures. In each model group, gastrointestinal motility was assayed and the histopathology of the small intestine was examined. Western blot and immunohistochemical analyses of jejunal tissue were performed to detect c-kit protein expression, the level of which was compared with that of a control group. The results of ANOVA are expressed as mean ± standard deviation. RESULTS In mice with multiple fractures, food intake was greatly reduced, consistent with histopathological evidence of an injured intestinal epithelium. The jejunal tissue of mice in groups a, c, f, and h was characterized by extensively necrotic and exfoliated intestinal mucosal epithelium and inflammatory cell infiltration in the lamina propria. In the gastrointestinal function assay, gastrointestinal motility was significantly reduced in groups a, b, c, f, and g; these group also had a higher ISS (p < 0.01). The expression of c-kit protein in groups with gastrointestinal dysfunction was significantly up-regulated (p < 0.001) compared with the control group. The close correlation between c-kit expression and the ISS indicated an influence of trauma severity on gastrointestinal motility. CONCLUSION Gastrointestinal dysfunction after multiple fractures was successfully reproduced in a mouse model. In these mice, c-kit expression correlated with gastrointestinal tissue dysfunction and might serve as a therapeutic target.
Collapse
Affiliation(s)
- Shi-Jie Meng
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Meng-Qiang Fan
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jian-Sheng Qian
- The Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jing-Wen Zhang
- Research and Development Department, Cell Resource Bank and Integrated Cell Preparation Center of Xiaoshan District, Hangzhou, China
| | - Hui-Hui Xu
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yang Zheng
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Wei-Qiang Zhao
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Le-Tian Shan
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jie-Feng Huang
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| |
Collapse
|
3
|
Chen KB, Wu ZW, Wang J, Zhu LH, Jin XL, Chen GF, Kang MX, Huang Y, Zhang H, Lin LL, Shi DK, Wu D, Chen JF, Chen J, Zhao ZQ. Efficacy and safety of long-term transcutaneous electroacupuncture versus sham transcutaneous electroacupuncture for delayed gastric emptying after distal gastrectomy: study protocol for a randomized, patient-assessor blinded, controlled trial. Trials 2022; 23:189. [PMID: 35241130 PMCID: PMC8895584 DOI: 10.1186/s13063-022-06108-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
Background Delayed gastric emptying (DGE) after distal gastrectomy impacts patients’ nutritional status and quality of life. The current treatments of DGE seem unsatisfactory or need invasive interventions. It is unknown whether transcutaneous electroacupuncture (TEA) is effective in treating DGE. Methods A total of 90 eligible participants who underwent distal gastrectomy will be randomly allocated to either the TEA group (n = 60) or the sham transcutaneous electroacupuncture (sham-TEA) group (n = 30). Each participant will receive TEA on the bilateral acupoints of Zusanli (ST36) and Neiguan (PC6) for 4 weeks. The primary outcomes will be the residual rates of radioactivity in the stomach by gastric scintigraphy and total response rates. The secondary outcomes will be endoscopic features, autonomic function, nutritional and psychological status, serum examination, and quality of life (QoL). The adverse events will also be reported. The patients will be followed up 1 year after the treatment. Discussion The findings of this randomized trial will provide high-quality evidence regarding the efficacy and safety of long-term TEA for treating DGE after distal gastrectomy. Trial registration Chinese Clinical Trial Registry ChiCTR2000033965. Registered on 20 June 2020
Collapse
Affiliation(s)
- Kai-Bo Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Zhi-Wei Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Jun Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Ling-Hua Zhu
- Department of Gastrointestinal Surgery, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, No. 3 East Qing-Chun Road, Hangzhou, 310020, China
| | - Xiao-Li Jin
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Guo-Feng Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Mu-Xing Kang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Yi Huang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Hang Zhang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Le-Le Lin
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Di-Ke Shi
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Dan Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Jian-Feng Chen
- Department of General Surgery, Shang-Yu branch of SAHZU, School of Medicine, No. 517 Shi-Min Road, Shaoxing, 312300, China
| | - Jian Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Zhi-Qing Zhao
- Department of General Surgery, Shang-Yu branch of SAHZU, School of Medicine, No. 517 Shi-Min Road, Shaoxing, 312300, China.
| |
Collapse
|
4
|
A Systematic Review and Network-Meta-Analysis of Gastro-Enteric Reconstruction Techniques Following Pancreatoduodenectomy to Reduce Delayed Gastric Emptying. World J Surg 2021; 44:2314-2322. [PMID: 32166469 DOI: 10.1007/s00268-020-05459-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This network meta-analysis aimed to identify the reconstruction technique associated with lowest rates of DGE following pancreatoduodenectomy (PD) from randomised controlled trials (RCTs). METHODS A systematic literature search of PubMed, Embase and MEDLINE databases was carried out using the PRISMA framework to identify all RCTs comparing reconstruction techniques of gastrojejunostomy after PD, with overall DGE as the primary endpoint. The primary outcome measure was overall DGE. Secondary outcomes were grade B/C DGE, duration of nasogastric tube, time to solid food intake, overall and grade B/C pancreatic fistula, bile leaks, reoperation, length of hospital stay and in-hospital mortality. RESULTS The search strategy identified eight RCTs including 761 patients. Six RCTs compared antecolic (n = 291 patients) and retrocolic Billroth II (n = 289 patients) reconstruction (n = 6 studies), and two RCTs compared antecolic Billroth II (n = 92 patients) and Roux-en-Y (n = 89 patients) reconstruction. Overall, antecolic Billroth II ranked best for overall and grade B/C DGE, bile leak, surgical site infection, length of stay and in-hospital mortality. Roux-en-Y was best for overall and grade B/C pancreatic fistula. CONCLUSION Antecolic Billroth II gastroenteric reconstruction is associated with the lowest rates of delayed gastric emptying after PD amongst the currently available techniques of gastrojejunostomy reconstructions.
Collapse
|
5
|
Wu JZ, Orita H, Zhang S, Egawa H, Yube Y, Kaji S, Oka S, Fukunaga T. Easy fixation effects the prevention of Peterson’s hernia and Roux stasis syndrome. World J Gastrointest Surg 2020; 12:346-354. [PMID: 32904043 PMCID: PMC7448210 DOI: 10.4240/wjgs.v12.i8.346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/31/2020] [Accepted: 07/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic distal gastrectomy (LDG) for gastric cancer has been progressed and popular in Japan, since it was first described in 1994. Several reconstruction methods can be adopted according to remnant stomach size, and balance of pros and cons. Roux-en-Y (R-Y) reconstruction is a one of standard options after LDG. Its complications include Petersen’s hernia and Roux stasis syndrome. Here we report our ingenious attempt, fixation of Roux limb and duodenal stump, for decreasing the development of Petersen’s hernia and Roux stasis syndrome.
AIM To develop a method to decrease the development of Petersen’s hernia and Roux stasis syndrome.
METHODS We performed ante-colic R-Y reconstruction after LDG. After R-Y reconstruction, we fixed Roux limb onto the duodenal stump in a smooth radian. Via this small improvement in Roux limb, Roux limb was placed to the right of the ligament of Treitz. This not only changed the anatomy of the Petersen’s defect, but it also kept a fluent direction of gastrointestinal anastomosis and avoided a cross-angle after jejunojejunostomy. 31 patients with gastric cancer was performed this technique after R-Y reconstruction. Clinical parameters including clinicopathologic characteristics, perioperative outcomes, postoperative complication and follow-up data were evaluated.
RESULTS The operative time was (308.0 ± 84.6 min). This improvement method took about 10 min. Two (6.5%) patients experienced pneumonia and pancreatitis, respectively. No patient required reoperation or readmission. All patients were followed up for at least 3 year, and none of the patients developed postoperative complications related to internal hernia or Roux stasis syndrome.
CONCLUSION This 10 min technique is a very effective method to decrease the development of Petersen’s hernia and Roux stasis syndrome in patients who undergo LDG.
Collapse
Affiliation(s)
- Jian-Zhong Wu
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Juntendo University, Tokyo 1638001, Japan
- Department of Gastroenterology Surgery, Suzhou Ninth People’s Hospital, Nantong University, Suzhou 215000, Jiangsu Province, China
| | - Hajime Orita
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Juntendo University, Tokyo 1638001, Japan
| | - Shun Zhang
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Juntendo University, Tokyo 1638001, Japan
- Department of Surgery, Tongji University, Shanghai 200000, China
| | - Hiroyuki Egawa
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Juntendo University, Tokyo 1638001, Japan
| | - Yukinori Yube
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Juntendo University, Tokyo 1638001, Japan
| | - Sanae Kaji
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Juntendo University, Tokyo 1638001, Japan
| | - Shinichi Oka
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Juntendo University, Tokyo 1638001, Japan
| | - Tetsu Fukunaga
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Juntendo University, Tokyo 1638001, Japan
| |
Collapse
|
6
|
Duffey K, Hannon M, Yoo J, Perkons N, Intenzo C, Moleski S, DiMarino AJ. The impact of risk factors on gastroparesis at an urban medical center. Ann Gastroenterol 2020; 33:250-256. [PMID: 32382227 PMCID: PMC7196617 DOI: 10.20524/aog.2020.0475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/29/2020] [Indexed: 12/31/2022] Open
Abstract
Background Gastroparesis is a complex and poorly understood disease. The literature is lacking with respect to the epidemiology of patient comorbidities and their effect on gastric emptying. We aimed to describe the most common comorbid conditions among patients with gastroparesis in an urban population and quantify the effect of these comorbidities on the severity of delayed gastric emptying (DGE). Methods We examined the medical records of all patients diagnosed with gastroparesis at a quaternary care center between 2014 and 2015. The severity of DGE was analyzed after patients were stratified for possible causative etiologies. Likelihood ratio tests were used to assess the significance of demographic and scintigraphic variation in this population. Results Of the 221 patients, 56.1% were Caucasian and 31.7% were African American. Among these patients, 29.4% had evidence of medication-associated gastroparesis, 29.0% had diabetes-associated gastroparesis, and 31.7% had idiopathic disease. African American patients with gastroparesis were more likely to have diabetic gastroparesis than patients of other races (P=0.01). There was a statistically significant relationship between the number of major risk factors and the severity of a patient's DGE (P=0.004). Conclusions Among a diverse urban population, patients with DGE often carry multiple comorbid conditions that serve as risk factors for the development of gastroparesis, including prescriptions for narcotic medications. Greater numbers of these comorbid conditions are associated with more severe disease. Demographics are significantly associated with the etiology and severity of gastroparesis; in particular, African American patients are more likely to have diabetic gastroparesis than patients of other races.
Collapse
Affiliation(s)
- Katherine Duffey
- Department of Medicine, Division of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA (Katherine Duffey, Michelle Hannon)
| | - Michelle Hannon
- Department of Medicine, Division of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA (Katherine Duffey, Michelle Hannon)
| | - Joseph Yoo
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA (Joseph Yoo, Stephanie Moleski, Anthony J. DiMarino)
| | - Nicholas Perkons
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Nicholas Perkons)
| | - Charles Intenzo
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Thomas Jefferson University, Philadelphia, PA (Charles Intenzo), USA
| | - Stephanie Moleski
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA (Joseph Yoo, Stephanie Moleski, Anthony J. DiMarino)
| | - Anthony J DiMarino
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA (Joseph Yoo, Stephanie Moleski, Anthony J. DiMarino)
| |
Collapse
|
7
|
Schorn S, Demir IE, Vogel T, Schirren R, Reim D, Wilhelm D, Friess H, Ceyhan GO. Mortality and postoperative complications after different types of surgical reconstruction following pancreaticoduodenectomy-a systematic review with meta-analysis. Langenbecks Arch Surg 2019; 404:141-157. [PMID: 30820662 DOI: 10.1007/s00423-019-01762-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 02/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pancreaticoduodenectomy/PD is a technically demanding pancreatic resection. Options of surgical reconstruction include (1) the child reconstruction defined as pancreatojejunostomy/PJ followed by hepaticojejunostomy/HJ and the gastrojejunostomy/GJ "the standard/s-Child," (2) the s-child reconstruction with an additional Braun enteroenterostomy "BE-Child," or (3) Isolated-Roux-En-Y-pancreaticojejunostomy "Iso-Roux-En-Y," in which the pancreas anastomosis is reconstructed in a separate loop after the GJ. Yet, the impact of these reconstruction methods on patients' outcome has not been sufficiently compared in a systematic manner. METHODS A systematic review and meta-analysis were conducted according to the Preferred-Reporting-Items-for-Systematic-review-and-Meta-Analysis/PRISMA-guidelines by screening Pubmed/Medline, Scopus, Cochrane Library and Web-of-Science. Articles meeting predefined criteria were extracted and meta-analysis was performed. RESULTS Nineteen studies were identified comparing BE-Child or Isolated-Roux-En-Y vs. s-Child. Compared to s-Child neither BE-Child (p = 0.43) nor Iso-Roux-En-Y (p = 0.94) displayed an impact on postoperative mortality, whereas BE-Child showed less postoperative complications (p = 0.02). BE-Child (p = 0.15) and Iso-Roux-En-Y (p = 0.61) did not affect postoperative pancreatic fistula/POPF in general, but BE-Child was associated with a decrease of clinically relevant POPF (p = 0.005), clinically relevant delayed gastric emptying/DGE B/C (p = 0.004), bile leaks (p = 0.01), and hospital stay (p = 0.06). BE-Child entailed also an increased operation time (p = 0.0002) with no impact on DGE A/B/C, hemorrhage, surgical site infections and pulmonary complications. CONCLUSION BE-Child is associated with a decreased risk for postoperative complications, particularly a decreased risk for clinically relevant DGE, POPF, and bile leaks, whereas Iso-Roux-En-Y does not seem to affect the clinical course after PD. Therefore, BE seems to be a valuable surgical method to improve patients' outcome after PD.
Collapse
Affiliation(s)
- Stephan Schorn
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Ihsan Ekin Demir
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Thomas Vogel
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Rebekka Schirren
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniel Reim
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Dirk Wilhelm
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Helmut Friess
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Güralp Onur Ceyhan
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| |
Collapse
|
8
|
Kim SH, Keum B, Choi HS, Kim ES, Seo YS, Jeen YT, Lee HS, Chun HJ, Um SH, Kim CD, Park S. Self-expandable metal stents in patients with postoperative delayed gastric emptying after distal gastrectomy. World J Gastroenterol 2018; 24:4578-4585. [PMID: 30386107 PMCID: PMC6209569 DOI: 10.3748/wjg.v24.i40.4578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/11/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the efficacy and safety of endoscopic stent insertion in patients with delayed gastric emptying after gastrectomy.
METHODS In this study, we prospectively collected data from patients who underwent stent placement for delayed gastric emptying (DGE) after distal gastrectomy between June 2010 and April 2017, at a tertiary referral academic center. Clinical improvement, complications, and consequences after stent insertion were analyzed.
RESULTS Technical success was achieved in all patients (100%). Early symptom improvement was observed in 15 of 20 patients (75%) and clinical success was achieved in all patients. Mean follow-up period was 1178.3 ± 844.1 d and median stent maintenance period was 51 d (range 6-2114 d). During the follow-up period, inserted stents were passed spontaneously per rectum without any complications in 14 of 20 patients (70%). Symptom improvement was maintained after stent placement without the requirement of any additional intervention in 19 of 20 patients (95%).
CONCLUSION Endoscopic stent placement provides prompt relief of obstructive symptoms. Thus, it can be considered an effective and safe salvage technique for post-operative DGE.
Collapse
Affiliation(s)
- Seung Han Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Yeon Seok Seo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Soon Ho Um
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Chang Duck Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Sungsoo Park
- Division of Upper GI Surgery, Department of Surgery, Korea University College of Medicine, Seoul 02841, South Korea
| |
Collapse
|
9
|
Matsumoto S, Wakatsuki K, Migita K, Ito M, Nakade H, Kunishige T, Kitano M, Nakatani M, Sho M. Predictive Factors for Delayed Gastric Emptying after Distal Gastrectomy with Roux-en-Y Reconstruction. Am Surg 2018. [DOI: 10.1177/000313481808400670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Delayed gastric emptying (DGE) after distal gastrectomy (DG) followed by Roux-en-Y (R-Y) reconstruction is one of the most worrisome complications, and the course of DGE has not been completely elucidated. This retrospective study aimed to evaluate the frequency of DGE after DG followed by R-Y reconstruction for gastric cancer and identify the risk factors for its development. This study included 266 patients with gastric cancer who underwent DG followed by R-Y reconstruction between 2005 and 2016. We compared clinicopathological characteristics and surgical procedures between the DGE group and non-DGE group. DGE occurred in 24 of the 266 patients. There were no relationships of gender, age, TNM stage, historical grade, surgical approach, extent of lymphadenectomy, preservation of the vagal nerve, and reconstruction route with DGE development. Body mass index (BMI) was higher in DGE patients than in non-DGE patients (P = 0.053). Univariate analysis revealed that a tumor located in the lower third of the stomach (P = 0.005) and isoperistaltic reconstruction (P = 0.043) were significant factors for DGE. Multivariate analysis showed that a tumor located in the lower third of the stomach (P = 0.007), isoperistaltic reconstruction (P = 0.044), and BMI (P = 0.034) were significant predictors of DGE. Our findings suggest that tumor location, the direction of peristalsis for gastrojejunostomy, and BMI are associated with DGE after R-Y reconstruction.
Collapse
Affiliation(s)
- Sohei Matsumoto
- From the Department of Surgery, Nara Medical University School of Medicine, Nara, Japan
| | - Kohei Wakatsuki
- From the Department of Surgery, Nara Medical University School of Medicine, Nara, Japan
| | - Kazuhiro Migita
- From the Department of Surgery, Nara Medical University School of Medicine, Nara, Japan
| | - Masahiro Ito
- From the Department of Surgery, Nara Medical University School of Medicine, Nara, Japan
| | - Hiroshi Nakade
- From the Department of Surgery, Nara Medical University School of Medicine, Nara, Japan
| | - Tomohiro Kunishige
- From the Department of Surgery, Nara Medical University School of Medicine, Nara, Japan
| | - Mutsuko Kitano
- From the Department of Surgery, Nara Medical University School of Medicine, Nara, Japan
| | - Mitsuhiro Nakatani
- From the Department of Surgery, Nara Medical University School of Medicine, Nara, Japan
| | - Masayuki Sho
- From the Department of Surgery, Nara Medical University School of Medicine, Nara, Japan
| |
Collapse
|
10
|
Uchida M, Kobayashi O, Shimizu K. Gastric emptying after artificial ulceration in rats: differences due to the site of the ulcer and the effects of prokinetic drugs. J Smooth Muscle Res 2017; 53:48-56. [PMID: 28652516 PMCID: PMC5487827 DOI: 10.1540/jsmr.53.48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to evaluate the effects of the position of
an acetic acid-induced gastric ulcer and the effects of prokinetic drugs on gastric
emptying. Materials and Methods Male Sprague-Dawley rats were used in
this study. Acetic acid ulcers were induced either in the region between the fundus and
pylorus on the anterior wall of the stomach or in the glandular region on the greater
curvature of the stomach to determine whether there were regional differences in the
effect of the ulcers. Gastric emptying was evaluated with a breath test using
[1-13C] acetic acid. In addition, the effects of the prokinetic drugs,
metoclopramide and mosapride, on gastric emptying were also evaluated.
Results Acetic acid induced ulcers in the region between the fundus and
pylorus on the anterior wall of the stomach significantly delayed gastric emptying as
compared with control rats, but not the acetic acid induced ulcers in the glandular region
on the greater curvature of the stomach. Metoclopramide and mosapride did not improve the
delayed gastric emptying even at doses that enhanced gastric emptying in normal rats.
Conclusion These findings show that gastric emptying is influenced by
the position of the ulcer and the region between the fundus and pylorus on the anterior
wall plays an important role in gastric emptying. Moreover, it was found that
metoclopramide and mosapride do not improve the delayed gastric emptying caused by acetic
acid ulcers induced on the anterior wall in the region between the fundus and pylorus.
Collapse
Affiliation(s)
- Masayuki Uchida
- Food Science Research Laboratories, Division of Research and Development, Meiji Co., Ltd., Japan
| | - Orie Kobayashi
- Food Science Research Laboratories, Division of Research and Development, Meiji Co., Ltd., Japan
| | - Kimiko Shimizu
- Food Science Research Laboratories, Division of Research and Development, Meiji Co., Ltd., Japan
| |
Collapse
|
11
|
Abstract
The number of persons 60 years and older has increased 3-fold between 1950 and 2000. Aging alone does not greatly impact the gastrointestinal (GI) tract. Digestive dysfunction, including esophageal reflux, achalasia, dysphagia, dyspepsia, delayed gastric emptying, constipation, fecal incontinence, and fecal impaction, is a result of the highly prevalent comorbid conditions and the medications with which those conditions are treated. A multidisciplinary approach with the expertise of a geriatrician, gastroenterologist, neurologist, speech pathologist, and physical therapist ensures a comprehensive functional and neurological assessment of the older patient. Radiographic and endoscopic evaluation may be warranted in the evaluation of the symptomatic older patient with consideration given to the risks and benefits of the test being used. Treatment of the digestive dysfunction is aimed at improving health-related quality of life if cure cannot be achieved. Promotion of healthy aging, treatment of comorbid conditions, and avoidance of polypharmacy may prevent some of these digestive disorders. The age-related changes in GI motility, clinical presentation of GI dysmotility, and therapeutic principles in the symptomatic older patient are reviewed here.
Collapse
|
12
|
Almukainzi M, Jamali F, Aghazadeh-Habashi A, Löbenberg R. Disease specific modeling: Simulation of the pharmacokinetics of meloxicam and ibuprofen in disease state vs. healthy conditions. Eur J Pharm Biopharm 2016; 100:77-84. [PMID: 26752427 DOI: 10.1016/j.ejpb.2015.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 11/01/2015] [Accepted: 12/14/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE Studies have shown altered pharmacokinetic patterns (PK) in patient suffering from acute pain. Thus, we aimed to simulate pharmacokinetics of meloxicam and ibuprofen in pain and pain-free states using a physiological based software program to identify the underlining mechanistic changes for the observed differences. METHOD Published in vivo data of meloxicam and ibuprofen were used for the simulations. Two drug formulations were studied: a fast dissolving (FD) and regular release (RR) tablet formulation. The oral bioavailability was compared between these formulations in vagally suppressed rats (gastric dysfunction) and a control group. For ibuprofen additional human data of a control and post dental surgery group were used. All simulations were performed using GastroPlus™. The in vivo drug release and PK of all formulations were estimated for both drugs using the software's immediate release (IR) or gastric release (GR) models. RESULT For meloxicam, the IR model predicted the in vivo absorption in the control group after administration of the FD and RR formulations. When gastric dysfunction was induced, the IR model did not predict absorption while the GR model did for both formulations, FD and RR. For ibuprofen, the predictions were also very close for both formulations, using the IR model for the control group and the GR model for the vagally suppressed condition in rats and humans. CONCLUSIONS Gastric control of the drug release in pain/disease state was identified as the major factor causing the observed differences in the pharmacokinetics. Computer simulations of disease states can be employed to optimize drug release from dosage forms to overcome the reported shortfalls in the drug absorption.
Collapse
Affiliation(s)
- May Almukainzi
- Faculty of Pharmacy & Pharmaceutical Science, University of Alberta, Edmonton, AB, Canada
| | - Fakhreddin Jamali
- Faculty of Pharmacy & Pharmaceutical Science, University of Alberta, Edmonton, AB, Canada
| | - Ali Aghazadeh-Habashi
- Faculty of Pharmacy & Pharmaceutical Science, University of Alberta, Edmonton, AB, Canada
| | - Raimar Löbenberg
- Faculty of Pharmacy & Pharmaceutical Science, University of Alberta, Edmonton, AB, Canada.
| |
Collapse
|
13
|
A Long Gastrojejunostomy Is Associated With Decreased Incidence and Severity of Delayed Gastric Emptying After Pancreaticoduodenectomy. Pancreas 2015; 44:1273-9. [PMID: 26390414 DOI: 10.1097/mpa.0000000000000415] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD) is associated with increased hospital length of stay (LOS) and health care costs. We hypothesized that a long gastrojejunostomy for PD (LGPD) is associated with decreased incidence of DGE. METHODS Data were reviewed from patients who underwent standard PD (SPD), pylorus-preserving PD (PPPD), or LGPD with a 9-cm-long anastomosis between August 2000 and July 2010. Primary outcomes included presence and grade of DGE and LOS. The International Study Group of Pancreatic Surgery definition was used to define DGE. RESULTS A total of 194 PDs (28 SPDs, 82 PPPDs, and 84 LGPDs) were performed. The rates of DGE were 46.4%, 37.8%, and 16.7%, respectively (P = 0.001). The LGPD was associated with fewer grades B/C DGE (2.4%) compared to SPD (10.7%) and PPPD (17.5%). Rates of postoperative abdominal fluid collection and abscess were similar among the groups. Patients with DGE had significantly longer LOS (14.0 vs 7.0 days, P < 0.001). CONCLUSIONS This is the first study evaluating the effect of a long gastrojejunostomy on the incidence of DGE after PD. The LGPD is associated with significantly decreased DGE compared to SPD and PPPD and warrants further exploration as a means to improve outcome for patients who undergo PD.
Collapse
|
14
|
Du P, Hameed A, Angeli TR, Lahr C, Abell TL, Cheng LK, O’Grady G. The impact of surgical excisions on human gastric slow wave conduction, defined by high-resolution electrical mapping and in silico modeling. Neurogastroenterol Motil 2015; 27:1409-22. [PMID: 26251163 PMCID: PMC4598186 DOI: 10.1111/nmo.12637] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/20/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gastric contractions are coordinated by slow waves, generated by interstitial cells of Cajal (ICC). Gastric surgery affects slow wave conduction, potentially contributing to postoperative gastric dysfunction. However, the impact of gastric cuts on slow waves has not been comprehensively evaluated. This study aimed to define consequences of surgical excisions on gastric slow waves by applying high-resolution (HR) electrical mapping and in silico modeling. METHODS Patients undergoing gastric stimulator implantation (n = 10) underwent full-thickness stapled excisions (25 × 15 mm, distal corpus) for histological evaluation, enabling HR mapping (256 electrodes; 36 cm(2) ) over and adjacent to excisions. A biophysically based in silico model of bidirectionally coupled ICC networks was developed and applied to investigate the underlying conduction mechanisms and importance of excision orientation. KEY RESULTS Normal gastric slow waves propagated aborally (3.0 ± 0.2 cpm). Excisions induced complete conduction block and wavelets that rotated around blocks, then propagated rapidly circumferentially distal to the blocks (8.5 ± 1.2 vs normal 3.6 ± 0.4 mm/s; p < 0.01). This 'conduction anisotropy' homeostatically restored antegrade propagating gastric wavefronts distal to excisions. Excisions were associated with complex dysrhythmias in five patients: retrograde propagation (3/10), ectopics (3/10), functional blocks (2/10), and collisions (1/10). Simulations demonstrated conduction anisotropy emerged from bidirectional coupling within ICC layers and showed transverse incision length and orientation correlated with the degree of conduction distortion. CONCLUSIONS & INFERENCES Orienting incisions in the longitudinal gastric axis causes least disruption to electrical conduction and motility. However, if transverse incisions are made, a homeostatic mechanism of gastric conduction anisotropy compensates by restoring aborally propagating wavefronts. Complex dysrhythmias accompanying excisions could modify postoperative recovery in susceptible patients.
Collapse
Affiliation(s)
- Peng Du
- Auckland Bioengineering Institute, University of Auckland, New Zealand
| | - Ahmer Hameed
- Division of Surgery, Westmead Hospital, Sydney, Australia
| | - Timothy R. Angeli
- Auckland Bioengineering Institute, University of Auckland, New Zealand
| | - Christopher Lahr
- Department of Surgery, Mississippi Medical Center, Jackson, Mississippi, USA
| | - Thomas L. Abell
- Department of Gastroenterology, University of Louisville, Louisville, Kentucky, USA
| | - Leo K. Cheng
- Auckland Bioengineering Institute, University of Auckland, New Zealand,Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - Gregory O’Grady
- Auckland Bioengineering Institute, University of Auckland, New Zealand,Department of Surgery, University of Auckland, New Zealand
| |
Collapse
|
15
|
Smolskas E, Lunevicius R, Samalavicius NE. Quality of life after subtotal gastrectomy for gastric cancer: Does restoration method matter? - A retrospective cohort study. Ann Med Surg (Lond) 2015; 4:371-5. [PMID: 26904188 PMCID: PMC4720718 DOI: 10.1016/j.amsu.2015.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 08/09/2015] [Accepted: 08/31/2015] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the impact on the quality of life (QoL) status of three gastrointestinal continuity restoration methods following a subtotal gastrectomy in patients with gastric cancer. METHODS QoL data from 153 patients were obtained and evaluated in this retrospective cross-sectional case series study. A list of patients who responded to questionnaires on QoL was stratified into three arms based on which gastrointestinal continuity restoration method was used - Billroth I (n = 37), Roux-en-Y (n = 15), and Balfour (n = 101). RESULTS The mean global health status scores for the patients following the Billroth I, Roux-en-Y and Balfour reconstructive surgery arms were 62 ± 20.09, 61 ± 24.08 and 56 ± 21.2, respectively, (p = 0.182). The mean scores of the functional scales were not lower than 60 in any of the patient groups. For physical, role, cognitive, social functional scales, the Billroth I method had the best mean QoL score. Comparisons of the global QoL, functional activities, and majority of the postgastrectomy symptom scores at different time points after the surgeries (6-12 months vs > 1 year) did not reveal major significant differences between the groups. However, the results highlighted trends and ranked the gastrointestinal continuity restoration methods over time. CONCLUSIONS The best QoL scores were obtained from the patients who underwent the Billroth I surgery. The Roux-en-Y method was better than the Balfour method 6-12 months after surgery. However, the Balfour method was better than the Roux-en-Y after one year. Further prospective randomized controlled trials are needed.
Collapse
Affiliation(s)
- Edgaras Smolskas
- Vilnius University Hospital Santariskes Clinics, 2 Santariskiu Str, LT-08661, Vilnius, Lithuania
| | - Raimundas Lunevicius
- Emergency General Surgery and Major Trauma Centre, General Surgery Department, Aintree University Hospital NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - Narimantas Evaldas Samalavicius
- Clinic of Internal Diseases, Family Medicine and Oncology of Medical Faculty, Institute of Oncology, Vilnius University, 1 Santariskiu Str, LT-08660, Vilnius, Lithuania
| |
Collapse
|
16
|
Skipenko OG, Bedzhanjan K, Shatverjan D, Bagmet K, Chardarov K. [Prevention of gastrostasis after pancreaticoduodenal resection: new technique of gastroenterostomy]. Khirurgiia (Mosk) 2015:17-30. [PMID: 26081183 DOI: 10.17116/hirurgia2015417-30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It was performed a retrospective comparative analysis of treatment results of 113 patients with pancreatic head and periampular cancer. The main group consisted of 58 patients in whom pancreaticoduodenal resection was performed according to an original technique of Russian Scientific Center of Surgery. Control group included 55 patients who underwent end-to-side gastrojejunostomy reconstruction. We have analyzed immediate postoperative complications in 2 groups without taking into consideration nosological forms of the disease. Pancreaticojejunostomy failure was diagnosed postoperatively in 5 (8.6%) patients in main group and in 10 (18.2%) patients in control group. There was no hepaticoentero- and gastroenterostomy failure in patients who underwent new technique of gastrojejunostomy while these events were observed in 8 (14.5%) and 3 (5.5%) patients respectively in control group. Mortality was 1.7% (n=1) in main group and 5.5% (n=3) in control group (p=0.29). Mild degree of gastrostasis (A class) was observed in 54 (93.7%) patients of main group and in 34 (61.8%) patients of control group (p=0.0004). There was B class of gastrostasis in 4 (6.9%) patients of main group. Severe gastrostasis (C class) was not revealed in any observation. In control group B class of gastrostasis was diagnosed in 14 (25.5%) patients, severe degree - in 7 (12.7%) patients. Univariant analysis showed hemotransfusion (p=0.037), pancreatic fistula (p=0.001), enteric fistula (p=0.005) and reconstruction technique (p=0.00004) as predictors of gastrostasis. Multivariant analysis defined pancreatic fistula (p=0.01), enteric fistula (p=0.04) and reconstruction technique (p=0.001) as significant predictors of gastrostasis. Thus, our study revealed significant decreasing gastrostasis incidence in case of original technique in comparison with conventional anastomosis, as well as demonstrated effect of anastomoses failure on augmentation of gastrostasis frequency after pancreaticoduodenal resection. Further randomized investigations are necessary to confirm our results.
Collapse
Affiliation(s)
- O G Skipenko
- acad. B.V. Petrovskiy Russian Research Surgery Center
| | - K Bedzhanjan
- acad. B.V. Petrovskiy Russian Research Surgery Center
| | - D Shatverjan
- acad. B.V. Petrovskiy Russian Research Surgery Center
| | - K Bagmet
- acad. B.V. Petrovskiy Russian Research Surgery Center
| | - K Chardarov
- acad. B.V. Petrovskiy Russian Research Surgery Center
| |
Collapse
|
17
|
Otsuka R, Natsume T, Maruyama T, Tanaka H, Matsuzaki H. Antecolic reconstruction is a predictor of the occurrence of roux stasis syndrome after distal gastrectomy. J Gastrointest Surg 2015; 19:821-4. [PMID: 25693423 DOI: 10.1007/s11605-015-2770-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/02/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Roux-en-Y reconstruction after distal gastrectomy can result in delayed gastric emptying, called Roux stasis syndrome (RSS). The cause of RSS has not been completely identified. This study retrospectively investigated the development of RSS. METHODS Between April 2008 and March 2014, we performed 138 procedures with distal gastrectomy using Roux-en-Y reconstruction. The development of RSS was analyzed and examined for correlations with the length of the operation, amount of blood loss, and surgical procedure. RESULTS RSS was observed in 16 of the 138 patients. There were no relationships between the length of the operation or amount of blood loss and the development of RSS according to the Mann-Whitney U test. There were also no significant differences in the development of RSS between the patients treated with laparotomy and laparoscopic surgery, end-to-side, side-to-side, or end-to-end anastomosis or isoperistaltic or antiperistaltic anastomosis, as determined using the chi-square test. However, the development of RSS tended to lower in the patients who underwent laparoscopic surgery, side-to-side anastomosis, and isoperistaltic anastomosis. In addition, there was a significant difference between the patients who received antecolic and retrocolic reconstruction (p=0.005). CONCLUSIONS Our findings suggest that antecolic reconstruction correlates with a lower likelihood of developing RSS.
Collapse
Affiliation(s)
- Ryota Otsuka
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1, Kanasugi, Funabashi-shi, Chiba, 273-8588, Japan,
| | | | | | | | | |
Collapse
|
18
|
Bickelhaupt S, Froehlich JM, Cattin R, Raible S, Bouquet H, Bill U, Patak MA. Software-supported evaluation of gastric motility in MRI: a feasibility study. J Med Imaging Radiat Oncol 2015; 58:11-7. [PMID: 24131557 DOI: 10.1111/1754-9485.12097] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 06/07/2013] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the feasibility of dedicated motility assessment software for quantitative evaluation of basic gastric motility and to validate it using manual measurements. METHODS Ten patients (5 males/5 females, mean 41 years) out of a previous series of small bowel MR-enterography examinations with well visible stomachs were included in this Institutional Reviews Board approved, retrospective study. MRI (1.5-T, Siemens Sonata) was performed after standardised oral preparation (3% aqueous mannitol over 1 h). Coronal 2DtrueFISP (TR 283.8/TE 1.89/FOV400/10 mm slice) motility acquisitions covering the entire abdomen were performed in apnoea. For each patient, image analysis for assessment of gastric motility was performed both manually and using the dedicated software either the proximal (n = 5) or in the distal (n = 5) gastric corpus. The main quantitative endpoints (amplitude, frequency) describing gastric motility were compared using (paired) Student's t-Test. RESULTS All motility curves qualitatively matched each other (10/10). No significant differences (P > 0.05) were found for amplitudes (mean: 18.17 mm manual; 17.78 mm software), contraction frequencies (5.1/min; 4.7/min) and mean lumen diameters (34.12 mm; 33.13 mm), respectively. Mean duration for a single measurement was significantly (P < 0.001) lower with the software (6.40 min manual technique; 1.40 min software assisted). CONCLUSIONS The software proves to be feasible for fast and accurate measurement of basic gastric motility parameters providing comparable data in comparison to manual assessment methods. It might help to reduce the time needed for assessment of relevant characteristics of gastric motility.
Collapse
|
19
|
Bickelhaupt S, Froehlich JM, Patak MA. Automated small bowel motility measurements in MRI using 2D coronal slices - does the intrasegmental location matter? A pilot study. Clin Imaging 2014; 39:89-93. [PMID: 25457530 DOI: 10.1016/j.clinimag.2014.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 12/30/2022]
Abstract
INTRODUCTION To evaluate if small bowel motility analyses are influenced by the positioning of the 2D-cross-section measurement point within the lumen. MATERIALS AND METHODS Forty-four small-bowel motility measurements were included in this institutional review board-approved, prospective study. Motility sequences (Dixon-dynFFE; Temporal-resolution 1s, breath-hold) of the ileocecal region were acquired using magnetic resonance imaging (3.0-Tesla; Ingenia-Philips). Motility was analyzed in three different compartments of the small bowel lumen (ventral, central, dorsal). Curve characteristics were statistically compared. RESULTS Mean luminal diameter, contraction amplitudes (P>.05) and the extent of luminal occlusion during contraction (P=.11) did not differ significantly between the compartments (ventral/central/dorsal) of the bowel lumen. CONCLUSION Quantitative motility parameters are not substantially influenced by the choice of cross sections on coronal planes as long as the segment is visible throughout the measurement.
Collapse
Affiliation(s)
- Sebastian Bickelhaupt
- Department of Radiology, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Johannes M Froehlich
- Department of Radiology, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Michael A Patak
- Department of Radiology, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland; Department of Radiology, Hirslanden Clinics Zürich, Witellikerstrasse 40, 8032 Zürich, Switzerland.
| |
Collapse
|
20
|
Li MZ, Deng L, Wang JJ, Xiao LB, Wu WH, Yang SB, Li WF. Surgical outcomes and prognostic factors of T4 gastric cancer patients without distant metastasis. PLoS One 2014; 9:e107061. [PMID: 25211331 PMCID: PMC4161379 DOI: 10.1371/journal.pone.0107061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/05/2014] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate surgical outcomes and prognostic factors for T4 gastric cancer treated with curative resection. Methods Between January 1994 and December 2008, 94 patients diagnosed with histological T4 gastric carcinoma and treated with curative resection were recruited. Patient characteristics, surgical complications, survival, and prognostic factors were analyzed. Results Postoperative morbidity and mortality were 18.1% and 2.1%, respectively. Multivariate analysis indicated lymph node metastasis (hazard ratio, 2.496; 95% confidence interval, 1.218–5.115; p = 0.012) was independent prognostic factor. Conclusions For patients with T4 gastric cancer, lymph node metastasis was associated with poorer survival. Neoadjuvant chemotherapy or aggressive adjuvant chemotherapy after radical resection was strongly recommended for these patients.
Collapse
Affiliation(s)
- Ming-zhe Li
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liang Deng
- Department of General Surgery I, the Eastern Hospital of the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing-jing Wang
- Department of laboratory, Hexian Memory Hospital of Panyu District, Guangzhou, China
| | - Long-bin Xiao
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- * E-mail:
| | - Wen-hui Wu
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shi-bin Yang
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wen-feng Li
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
21
|
Does laparoscopic and endoscopic cooperative surgery for gastric submucosal tumors preserve residual gastric motility? Results of a retrospective single-center study. PLoS One 2014; 9:e101337. [PMID: 24968310 PMCID: PMC4072788 DOI: 10.1371/journal.pone.0101337] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 06/05/2014] [Indexed: 12/11/2022] Open
Abstract
Background Laparoscopic and endoscopic cooperative surgery (LECS) is a minimally invasive surgical technique used to resect gastric submucosal tumors with intraluminal growth. Endoscopic submucosal dissection is used to determine the appropriate resection line from within the stomach lumen as it minimizes the stomach wall resection area and prevents postoperative stomach deformity. Although LECS is intended to preserve gastric function, few reports have evaluated postoperative residual gastric motility. Therefore, we conducted a retrospective analysis of patients who underwent LECS to determine the effects of LECS on residual gastric motility. Methods Twenty-two patients underwent endoscopy 3 to 12 months after LECS. Patients were evaluated for endoscopic evidence of gastric motility disorder, namely food residue and occurrence/exacerbation of reflux esophagitis. We considered patients with new onset of gastric symptoms and endoscopic evidence of gastric motility disorder to have clinically relevant gastric motility disorder. We described patient characteristics, tumor location, and surgical findings. Results Two of 22 patients developed clinically relevant gastric motility disorder after LECS. In one of these patients, the symptoms were not severe; only one had reduced dietary intake and had lost weight. We identified clinically relevant gastric motility disorder in two patients with gastrointestinal stromal tumors located in the lesser curvature of the stomach. The major axis of these two tumors was 34 mm and 38 mm. Conclusions Many patients did not have clinically relevant gastric motility disorder after LECS. Further investigation is required to identify predisposing factors for gastric motility disorder.
Collapse
|
22
|
Liu Y, Song X, Zhang Y, Zhou L, Ni R. The effects of comprehensive mental intervention on the recovery time of patients with postsurgical gastroparesis syndrome. J Clin Nurs 2014; 23:3138-47. [PMID: 24702786 DOI: 10.1111/jocn.12554] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2013] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES To explore the effects of comprehensive mental intervention on the recovery time and symptoms of depression in patients with postsurgical gastroparesis syndrome. BACKGROUND Postsurgical gastroparesis syndrome may occur after abdominal surgery. The development of postsurgical gastroparesis syndrome is believed to be influenced by neuropsychiatric factors, manifest as psychological dysfunction and distress. DESIGN Randomised controlled trial. METHODS A total of 120 patients with postsurgical gastroparesis syndrome were randomly divided into a mental intervention group (n = 60) and a control group (n = 60) by odd or even numbers. The mental intervention group received comprehensive mental intervention including support, counselling, music and massage plus all aspects of conventional therapy. The control group received only conventional therapy, including a three-cavity gastric tube, fasting, parenteral/enteral nutrition, routine care and health guidance. Pre intervention and postintervention depression levels were assessed in both groups by the Center for Epidemiological Survey Depression Scale. Gastric function recovery was assessed in all patients. RESULTS Postintervention depression scores were significantly reduced in the mental intervention group, and pre-/postdifferences were significantly greater compared to control group scores. The mental intervention group had significantly shorter times for symptom disappearance (nausea, vomiting, abdominal distention), extubation duration, eating recovery, gastric drainage volume >600 ml/day, gastroparesis recovery, as well as shorter hospital stays and lower hospital expenses. CONCLUSIONS Comprehensive mental intervention improved negative emotions and depression and shortened recovery time of patients with postsurgical gastroparesis syndrome. RELEVANCE TO CLINICAL PRACTICE Mental intervention is important to postsurgical recovery, and primary nurses are encouraged to understand how to care for postsurgical patients physically and psychologically, with at least one nurse in the postsurgical setting trained to provide mental intervention.
Collapse
Affiliation(s)
- Yufen Liu
- Department of Gastrointestinal Surgery, China-Japan Friendship Hospital, Beijing, China
| | | | | | | | | |
Collapse
|
23
|
Krishna A, Bansal VK, Kumar S, Sridhar P, Kapoor S, Misra MC, Garg P. Preventing Delayed Gastric Emptying After Whipple's Procedure-Isolated Roux Loop Reconstruction With Pancreaticogastrostomy. Indian J Surg 2013; 77:703-7. [PMID: 26730093 DOI: 10.1007/s12262-013-0992-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 10/07/2013] [Indexed: 11/25/2022] Open
Abstract
Although delayed gastric emptying (DGE) after Whipple's pancreaticoduodenectomy is not life-threatening and can be treated conservatively, it results in discomfort and significant prolongation of the hospital stay and adds on to the hospital costs. To overcome this problem, we started using the isolated loop technique of reconstruction along with pancreaticogastrostomy and we present our series using this technique. All consecutive patients undergoing Whipple's pancreaticoduodenectomy in a single surgical unit from January 2009 until December 2012 were included. In the absence of hepatic and peritoneal metastasis, resection (Whipple's procedure) with curative intent was done using isolated loop technique with pancreaticogastrostomy. Delayed gastric emptying was assessed clinically and on oral gastrograffin study. Bile reflux was also assessed on clinical parameters and evidence of beefy friable gastric mucosa on upper GI endoscopy and presence of reflux on hepatobiliary scintigraphy. A total of 52 patients were operated using this technique from January 2009 to October 2012. The mean operative time was 260.8 ± 50.3, and the mean operative blood loss was 1,068.0 ± 606.1 ml. Mean gastric emptying time 106.0 ± 6.1 min (89-258 min). Three out of the 52(5.7 %) patients had persistent vomiting in the post-operative period requiring reinsertion of NG tube. A HIDA scan done on POD7 for all patients did not show any evidence of bile reflux in any of the patients. Pancreatogastrostomy with isolated loop in pancreaticoduodenal resection markedly reduces the post-operative incidence of alkaline reflux gastritis and DGE.
Collapse
Affiliation(s)
- Asuri Krishna
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Subodh Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - P Sridhar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Sameer Kapoor
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Mahesh C Misra
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Pramod Garg
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| |
Collapse
|
24
|
Meng H, Zhou D, Jiang X, Ding W, Lu L. Incidence and risk factors for postsurgical gastroparesis syndrome after laparoscopic and open radical gastrectomy. World J Surg Oncol 2013; 11:144. [PMID: 23782501 PMCID: PMC3710071 DOI: 10.1186/1477-7819-11-144] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 06/01/2013] [Indexed: 12/27/2022] Open
Abstract
Background The aim of this study was to investigate the differences and influencing factors for postsurgical gastroparesis syndrome incidence after laparoscopic and open radical gastrectomy. Methods Clinical data were collected for 563 patients who underwent open radical gastrectomy for gastric cancer and 72 cases receiving laparoscopic radical gastrectomy. We retrospectively analyzed the incidence of postsurgical gastroparesis syndrome, clinical features, course of disease, and risk factors of these two groups. Results There was no statistical difference for the incident rate of postsurgical gastroparesis syndrome between laparoscopic and open radical gastrectomy (6.9% vs. 3.7%, P > 0.05). Preoperative outflow tract obstruction and Billroth II anastomosis were the two risk factors for postsurgical gastroparesis syndrome in the open radical gastrectomy group and the laparoscopic surgery for gastric cancer group. The same results were obtained from logistic regression statistical analysis. Age greater than 70 years was also one of the risk factors for postsurgical gastroparesis syndrome in the open radical gastrectomy group (P < 0.05). Conclusions Laparoscopic radical gastrectomy for gastric cancer does not increase the incident rate of postsurgical gastroparesis syndrome.
Collapse
Affiliation(s)
- Hongbo Meng
- Department of General Surgery, Tenth People's Hospital of Tongji University, Shanghai 200072, China
| | | | | | | | | |
Collapse
|
25
|
Dayton MT, Dempsey DT, Larson GM, Posner AR. New paradigms in the treatment of small bowel obstruction. Curr Probl Surg 2012; 49:642-717. [PMID: 23057861 DOI: 10.1067/j.cpsurg.2012.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Merril T Dayton
- Department of Surgery, SUNY Buffalo, Kaleida Health System, Buffalo, NY, USA
| | | | | | | |
Collapse
|
26
|
Kim KH, Kim MC, Jung GJ. Risk factors associated with delayed gastric emptying after subtotal gastrectomy with Billroth-I anastomosis using circular stapler for early gastric cancer patients. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 83:274-80. [PMID: 23166886 PMCID: PMC3491229 DOI: 10.4174/jkss.2012.83.5.274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 07/30/2012] [Accepted: 08/05/2012] [Indexed: 11/30/2022]
Abstract
Purpose Gastric surgery may potentiate delayed gastric emptying. Billroth I gastroduodenostomy using a circular stapler is the most preferable reconstruction method. The purpose of this study is to analyze the risk factors associated with delayed gastric emptying after radical subtotal gastrectomy with Billroth I anastomosis using a stapler for early gastric cancer. Methods Three hundred and seventy-eight patients who underwent circular stapled Billroth I gastroduodenostomy after subtotal gastrectomy due to early gastric cancer were analyzed retrospectively. One hundred and eighty-two patients had Billroth I anastomosis using a 25 mm diameter circular stapler, and 196 patients had anastomosis with a 28 or 29 mm diameter circular stapler. Clinicopathological features and postoperative outcomes were evaluated and compared between the two groups. Delayed gastric emptying was diagnosed by symptoms and simple abdomen X-ray with or without upper gastrointestinal series or endoscopy. Results Postoperative delayed gastric emptying was found in 12 (3.2%) of the 378 patients. Among all the variables, distal margin and circular stapler diameter were significantly different between the cases with delayed gastric emptying and no delayed gastric emptying. There were statistically significant differences in sex, body mass index, comorbidity, complication, and operation type according to circular stapler diameter. In both univariate and multivariate logistic regression analyses, only the stapler diameter was found to be a significant factor affecting delayed gastric emptying (P = 0.040). Conclusion In this study, the circular stapler diameter was one of the most significant predictable factors of delayed gastric emptying for Billroth I gastroduodenostomy. The use of a 28 or 29 mm diameter circular stapler rather than a 25 mm diameter stapler in stapled gastroduodenostomy for early gastric cancer can reduce postoperative delayed gastric emptying associated with anastomosic stenosis or edema with relative safety.
Collapse
Affiliation(s)
- Ki Han Kim
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
| | | | | |
Collapse
|
27
|
Masui T, Kubora T, Nakanishi Y, Aoki K, Sugimoto S, Takamura M, Takeda H, Hashimoto K, Tokuka A. The flow angle beneath the gastrojejunostomy predicts delayed gastric emptying in Roux-en-Y reconstruction after distal gastrectomy. Gastric Cancer 2012; 15:281-6. [PMID: 22041869 DOI: 10.1007/s10120-011-0107-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 09/23/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Delayed gastric emptying without mechanical obstruction after Roux-en-Y reconstruction has been defined as Roux stasis syndrome. It occurs in 10-30% of patients after such reconstruction. So far, the cause of this stasis has not been completely identified. This study aimed to reduce Roux stasis using surgical techniques. METHODS From November 2007 to October 2010, we performed 101 distal gastrectomies with Roux-en-Y reconstruction. All the gastrojejunostomies were performed with end-to-end anastomoses. Roux stasis was analyzed with respect to tumor location, extent of the dissection, tumor progression, operation time, antecolic/retrocolic reconstruction, and the shape of the gastrojejunostomy. The shape of the gastrojejunostomy was evaluated by contrast gastroradiography 4 days after the operation. RESULTS Roux stasis syndrome was observed in 17 of the 101 patients. There was no relationship between the extent of the dissection, tumor progression, or operation time and the occurrence of Roux stasis. There was no difference in the incidence of Roux stasis between antecolic and retrocolic reconstructions. However, the group that displayed a straight anastomotic shape on contrast radiography demonstrated an apparently lower incidence of Roux stasis (p = 0.0003). In addition, Roux-en-Y reconstruction following gastric cancer was more frequently followed by Roux stasis in the antrum than in the midstomach (p = 0.0036). Cases of Roux stasis occurred 11.8 days after surgery on average and resolved within 2 weeks on average. CONCLUSIONS Our findings demonstrate the substantial benefits of a straight anastomosis of the gastrojejunostomy for the prevention of Roux stasis syndrome.
Collapse
Affiliation(s)
- Toshihiko Masui
- Department of Surgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Larssen L, Hauge T, Medhus AW. Stent treatment of malignant gastric outlet obstruction: the effect on rate of gastric emptying, symptoms, and survival. Surg Endosc 2012; 26:2955-60. [PMID: 22538695 DOI: 10.1007/s00464-012-2291-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 03/29/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Advanced pancreatic cancer and other malignancies located proximal to the small bowel might cause gastric outlet obstruction (GOO) resulting in nausea, vomiting, dehydration, and malnutrition. Self-expandable metal stents (SEMS) to a large extent have replaced surgical treatment, with gastro-entero-anastomosis as palliative treatment for GOO. The aim of the present study was to evaluate the effect of duodenal stenting on the rate of gastric emptying, symptoms, and survival. METHODS Patients with endoscopically verified malignant obstruction of the proximal duodenum were included. Gastric emptying rate was measured prior to and within 1 week after stent placement using a meal containing (13)C-octanoic acid as a marker. Symptoms related to GOO were assessed by the patients before and 2 weeks after stent treatment and during the gastric emptying tests. All patients were followed up until death. RESULTS In the patients included (n = 17), all studied variables of gastric emptying improved significantly following treatment, and a reduction in self-reported obstructive symptoms was observed. There was no correlation between survival and the rate of gastric emptying before or after, or the change in the rate of emptying. CONCLUSION The present study demonstrated that treatment with SEMS results in improved gastric emptying in most patients with GOO and a corresponding reduction in self-reported obstruction symptoms. However, survival and emptying were not related. The present findings provide further evidence that treatment with stents is an effective palliative treatment in patients with GOO.
Collapse
Affiliation(s)
- Lene Larssen
- Department of Gastroenterology, Oslo University Hospital, Kirkeveien 166, Ullevål, 0407, Oslo, Norway.
| | | | | |
Collapse
|
29
|
Roux-en-Y reconstruction at greater curvature in biliopancreatic diversion: effects on early postoperative functional recovery. Obes Surg 2012; 21:1188-93. [PMID: 21399972 DOI: 10.1007/s11695-011-0378-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Delayed gastric emptying after distal gastrectomy and reconstruction of alimentary tract with a gastroenteric anastomosis can significantly influence early and late postoperative course and the length of hospital stay. The purpose of this study was to compare the effect on postoperative functional recovery of two different Roux-en-Y reconstructions: at the gastric greater curvature and at the transected gastric staple line in the Scopinaro's biliopancreatic diversion. We conducted comparative study; 80 patients were enrolled and divided in two groups: group A (RY-GC) and group B (RY-SL) with 40 patients in each group. We compared the early postoperative functional recovery for both groups measuring four parameters: gastric stasis indicated with the volume of the gastric fluid collected per 24 h, day of removal of the nasogastric tube, day of starting the oral intake, and day of hospital discharge. There was statistically significant (p < 0.001) reduction in gastric fluid volume in favor of the RY-GC group starting from the first postoperative day resulting in earlier removal of nasogastric tube with earlier starting of oral feeding than RY-SL group, with no symptoms of stasis required nutrition suspension; while three patients in RY-SL group experienced persistence of nausea and vomiting and needed nutrition suspension for several days. There was statistically significant (p < 0.001) reduction in the hospital stay for RY-GC group. Roux-en-Y reconstruction at the greater curvature ensures a rapid functional recovery with early hospital discharge. The use of stapler devices made this method easier and safer and no complications have arisen with mechanical anastomoses.
Collapse
|
30
|
Hornez E, Beyer L, Bourgouin S, Calvary R, Monchal T, Moutardier V, Orsonni P, Berdah S. Routine gastrostomy tube for gastric decompression in 55 consecutive pylorus-conserving pancreatoduodenectomy: retrospective analysis of the efficacy and tolerance. Clin Res Hepatol Gastroenterol 2011; 35:597-9. [PMID: 21664214 DOI: 10.1016/j.clinre.2011.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 04/20/2011] [Indexed: 02/04/2023]
|
31
|
Evers DJ, Smeenk RM, Bottenberg PD, van Werkhoven ED, Boot H, Verwaal VJ. Effect of preservation of the right gastro-epiploic artery on delayed gastric emptying after cytoreductive surgery and HIPEC: a randomized clinical trial. Eur J Surg Oncol 2011; 37:162-7. [PMID: 21216560 DOI: 10.1016/j.ejso.2010.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/30/2010] [Accepted: 12/06/2010] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Delayed gastric emptying (DGE) is a main complication with unknown origin after a cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC). The aim of this study was to investigate if preservation of the right gastro-epiploic artery (GEA) during standard omentectomy would have a positive effect on gastric emptying after CRS-HIPEC. METHODS Forty-two patients subjected to a CRS-HIPEC were randomized into two groups perioperatively before performing an omentectomy: in Group I (N = 21) omentectomy was performed with preservation of the GEA; in Group II (N = 21) omentectomy was performed with resection of the GEA. The primary endpoint was the number of days to full oral intake of solid food. Secondary endpoints were number of days to intended occlusion of gastrostomy catheter and total hospital admission time. RESULTS No significant differences were discovered between both groups in any of the study endpoints after CRS-HIPEC. No significant differences were observed in patient or operation characteristics between the randomized groups. CONCLUSIONS No association was demonstrated between preservation of the gastro-epiploic artery during omentectomy and gastric emptying after CRS-HIPEC. The extensive intestinal manipulation or the heated intra-peritoneal chemotherapy during surgery are more plausible causes of this phenomenon. This clinical trial was registered in the Netherlands at the Central Committee on Research involving Human Subjects (CCMO) under registration number P06.0301L.
Collapse
Affiliation(s)
- D J Evers
- Department of Surgery, The Netherlands Cancer Institute NKI-AVL, Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
32
|
Yue P, Qin MF, Wang Q, Zou FS. Assessment of functional delayed gastric emptying after laparoscopic reconstructive gastric surgeries. Shijie Huaren Xiaohua Zazhi 2010; 18:3245-3248. [DOI: 10.11569/wcjd.v18.i30.3245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify possible predictors of functional delayed gastric emptying (FDGE) after laparoscopic reconstructive gastric surgeries.
METHODS: The clinical data for 471 patients who underwent laparoscopic reconstructive gastric surgeries (including laparoscopic fundoplication, repair of hiatal hernia, adjustable gastric banding and Heller myotomy) from January 2001 to December 2009 were collected and analyzed retrospectively.
RESULTS: The possible predictors of FDGE after laparoscopic reconstructive gastric surgeries include: age over 65 years, a history of diabetes, preoperative hypoproteinemia, anxiety disorder, duration of surgery longer than 150 min, and preoperative abdominal infection (all P < 0.05).
CONCLUSION: The etiology of FDGE after laparoscopic reconstructive gastric surgeries is multi-factorial. The above-mentioned predictors are high risk factors for postoperative FDGE.
Collapse
|
33
|
Correlation between the length of the pyloric cuff and postoperative evaluation after pylorus-preserving gastrectomy. Gastric Cancer 2010; 13:109-16. [PMID: 20602198 DOI: 10.1007/s10120-010-0549-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 02/15/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent years have seen the preserved pyloric cuff being lengthened in pylorus-preserving gastrectomy for early gastric cancer. We performed clinical assessment of the symptoms after pylorus-preserving gastrectomy in patients treated at the National Cancer Center Hospital in Japan during the past 9 years. METHODS Four hundred and fifty-six patients who had undergone pylorus-preserving gastrectomy and been followed up for at least 3 years were studied. We classified the patients into two groups according to the length of the pyloric cuff (group A, within 3.0 cm; group B, more than 3.0 cm). Medical records were reviewed for further histological and follow-up data. A questionnaire regarding dumping syndrome and gastric stasis was also completed by the patients. RESULTS Our results showed no statistically significant differences in symptoms, such as dumping syndrome or emptying disturbances, between the two groups. CONCLUSION Our study revealed that the differences in several functions and symptom scales were not pronounced between the two groups. Regardless of the length of the pyloric cuff, pylorus-preserving gastrectomy can be utilized for the treatment of early gastric cancer even if the tumor is located proximal to the middle body.
Collapse
|
34
|
Fujita T, Katai H, Morita S, Saka M, Fukagawa T, Sano T. Short-term outcomes of Roux-en-Y stapled anastomosis after distal gastrectomy for gastric adenocarcinoma. J Gastrointest Surg 2010; 14:289-94. [PMID: 19904576 DOI: 10.1007/s11605-009-1082-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 10/26/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since 2003, we have begun to perform gastrojejunostomy by mechanical stapling for Roux-en-Y reconstruction in distal gastrectomy. We performed a retrospective study to compare the short-term outcomes of anastomosis by mechanical stapling and hand suturing. METHODS We evaluated the data of 701 consecutive patients of gastric adenocarcinoma who underwent conventional open distal gastrectomy with Roux-en-Y reconstruction. The data collected included details on the method used for the Roux-en-Y reconstruction, the disease stage, extent of lymph node dissection, performance rate of truncal vagotomy, operation time, operative blood loss, length of hospital stay, and postoperative complications. RESULTS The operation time was significantly shorter in the group in which mechanical stapling was used for the anastomosis (MS group) than in the group in which anastomosis was performed by hand suturing (HS group; 241.1 +/- 56.8 vs. 166.4 +/- 48.3 min; p < 0.05). Postoperatively, delayed gastric emptying occurred in 14 (1.9%) patients, including seven (4.2%) from the MS group and seven (1.3%) from the HS group (p = 0.038). CONCLUSION There were no significant disadvantages of employing mechanical stapling for anastomosis, except for the high rate of delayed gastric emptying. More consideration therefore needs to be given to decreasing the frequency of gastric emptying disturbance post surgery using mechanical staples.
Collapse
Affiliation(s)
- Takeshi Fujita
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | | | | | | | | | | |
Collapse
|
35
|
Nikfarjam M, Kimchi ET, Gusani NJ, Shah SM, Sehmbey M, Shereef S, Staveley-O'Carroll KF. A reduction in delayed gastric emptying by classic pancreaticoduodenectomy with an antecolic gastrojejunal anastomosis and a retrogastric omental patch. J Gastrointest Surg 2009; 13:1674-82. [PMID: 19548039 DOI: 10.1007/s11605-009-0944-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 06/03/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND Delayed gastric emptying (DGE) continues to be a major cause of morbidity following pancreaticoduodenectomy (PD). A change in the method of reconstruction following PD was instituted in an attempt to reduce the incidence DGE. METHODS Patients undergoing PD from January 2002 to December 2008 were reviewed and outcomes determined. Pylorus-preserving pancreaticoduodenectomy (PPPD) with a retrocolic duodenojejunal anastomosis (n = 79) or a classic PD with a retrocolic gastrojejunostomy (n = 36) was performed prior to January 2008. Thereafter, a classic PD with an antecolic gastrojejunal anastomosis and placement of a retrogastric vascular omental patch was undertaken (n = 36). RESULTS A statistically significant decrease in DGE was noted in the antecolic group compared to the entire retrocolic group (14% vs 40%; p = 0.004) and compared to patients treated by classic PD with a retrocolic anastomosis alone (14% vs 39%; p = 0.016). On multivariate analysis, the only modifiable factor associated with reduced DGE was the antecolic technique with an omental patch, odds ratio (OR) 0.3 (confidence interval (CI) 0.1-0.8) p = 0.022. Male gender was associated with an increased risk of DGE with OR 2.3 (CI 1.1-4.8) p = 0.026. CONCLUSION A classic PD combined with an antecolic anastomosis and retrogastric vascular omental patch results in a significant reduction in DGE.
Collapse
Affiliation(s)
- Mehrdad Nikfarjam
- Liver, Pancreas and Foregut Unit, Department of Surgery, Penn State College of Medicine, Hershey, PA 17033-0850, USA.
| | | | | | | | | | | | | |
Collapse
|
36
|
Hirao M, Kurokawa Y, Fujitani K, Tsujinaka T. Randomized controlled trial of Roux-en-Y versus rho-shaped-Roux-en-Y reconstruction after distal gastrectomy for gastric cancer. World J Surg 2009; 33:290-5. [PMID: 19023614 DOI: 10.1007/s00268-008-9828-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The main advantage of the Roux-en-Y (RY) operation is that it prevents bile and pancreatic juice from reaching the gastric mucosa, although the gastrojejunostomy may cause functional delayed gastric emptying (DGE), known as RY stasis syndrome. Rho-shaped Roux-en-Y reconstruction (rRY), an RY reconstruction with a rho-shaped anastomosis, is an established operation that has been found to be effective in preventing DGE. METHODS We conducted the randomized trial of RY versus rRY reconstruction after gastric cancer resection. The primary endpoint was the frequency of DGE, and secondary endpoints were the length of postoperative hospital stay, morbidity, and nutritional status. Seventy patients were enrolled, with 35 in each group. RESULTS The incidences of postoperative mortality and morbidity did not differ significantly between the two groups. There were no significant differences in nutritional status between the two groups after discharge. Delayed gastric emptying occurred in two patients (6%) in the RY group and four patients (11%) in the rRY group (P = 0.67). Logistic regression analysis revealed that truncal vagotomy was significantly associated with DGE inhibition. CONCLUSIONS Our findings showed that RY reconstruction after gastrectomy may be as simple and sufficient as conventional reconstruction.
Collapse
Affiliation(s)
- Motohiro Hirao
- Department of Surgery, Osaka National Hospital, 2-1-14, Hoenzaka, Chuouku, Osaka, 540-0006, Japan.
| | | | | | | |
Collapse
|
37
|
The effects on diet, anastomotic type, and loxiglumide on gastric emptying following gastrojejunostomy. Int J Surg 2009; 7:163-7. [DOI: 10.1016/j.ijsu.2009.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 12/25/2008] [Accepted: 01/27/2009] [Indexed: 12/31/2022]
|
38
|
Iqbal N, Lovegrove R, Tilney H, Abraham A, Bhattacharya S, Tekkis P, Kocher H. A comparison of pancreaticoduodenectomy with pylorus preserving pancreaticoduodenectomy: A meta-analysis of 2822 patients. Eur J Surg Oncol 2008; 34:1237-45. [DOI: 10.1016/j.ejso.2007.12.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 12/17/2007] [Indexed: 02/06/2023] Open
|
39
|
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007; 142:761-8. [PMID: 17981197 DOI: 10.1016/j.surg.2007.05.005] [Citation(s) in RCA: 2068] [Impact Index Per Article: 121.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2006] [Revised: 03/14/2007] [Accepted: 05/11/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Delayed gastric emptying (DGE) is one of the most common complications after pancreatic resection. In the literature, the reported incidence of DGE after pancreatic surgery varies considerably between different surgical centers, primarily because an internationally accepted consensus definition of DGE is not available. Several surgical centers use a different definition of DGE. Hence, a valid comparison of different study reports and operative techniques is not possible. METHODS After a literature review on DGE after pancreatic resection, the International Study Group of Pancreatic Surgery (ISGPS) developed an objective and generally applicable definition with grades of DGE based primarily on severity and clinical impact. RESULTS DGE represents the inability to return to a standard diet by the end of the first postoperative week and includes prolonged nasogastric intubation of the patient. Three different grades (A, B, and C) were defined based on the impact on the clinical course and on postoperative management. CONCLUSION The proposed definition, which includes a clinical grading of DGE, should allow objective and accurate comparison of the results of future clinical trials and will facilitate the objective evaluation of novel interventions and surgical modalities in the field of pancreatic surgery.
Collapse
Affiliation(s)
- Moritz N Wente
- Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Paraskevas KI, Avgerinos C, Manes C, Lytras D, Dervenis C. Delayed gastric emptying is associated with pylorus-preserving but not classical Whipple pancreaticoduodenectomy: A review of the literature and critical reappraisal of the implicated pathomechanism. World J Gastroenterol 2006; 12:5951-8. [PMID: 17009392 PMCID: PMC4124401 DOI: 10.3748/wjg.v12.i37.5951] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pylorus-preserving pancreaticoduodenectomy (PPPD) is nowadays considered the treatment of choice for periampullary tumors, namely carcinoma of the head, neck, or uncinate process of the pancreas, the ampulla of Vater, distal common bile duct or carcinoma of the peri-Vaterian duodenum. Delayed gastric emptying (DGE) comprises one of the most troublesome complications of this procedure. A search of the literature using Pubmed/Medline was performed to identify clinical trials examining the incidence rate of DGE following standard Whipple pancreaticoduodenectomy (PD) vs PPPD. Additionally we performed a thorough in-depth analysis of the implicated pathomechanism underlying the occurrence of DGE after PPPD. In contrast to early studies, the majority of recently performed clinical trials demonstrated no significant association between the occurrence of DGE with either PD or PPPD. PD and PPPD procedures are equally effective operations regarding the postoperative occurrence of DGE. Further randomized trials are required to investigate the efficacy of a recently reported (but not yet tested in large-scale studies) modification, that is, PPPD with antecolic duodenojejunostomy.
Collapse
|
41
|
Harrell AG, Sing RF, Novitsky YW, Kercher KW, Kuwada TS, Heniford BT. A re-evaluation of vagotomy and gastrojejunostomy for benign gastric outlet obstruction. J Laparoendosc Adv Surg Tech A 2006; 16:77-8; author reply 78. [PMID: 16494556 DOI: 10.1089/lap.2006.16.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
42
|
Pavlidis TE, Menenakos E. Practice in laparoscopic colectomy on human cadaver. J Laparoendosc Adv Surg Tech A 2006; 16:78-9. [PMID: 16494558 DOI: 10.1089/lap.2006.16.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
43
|
Siu WT. Author's Reply. J Laparoendosc Adv Surg Tech A 2006. [DOI: 10.1089/lap.2006.16.78.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
44
|
Maetani I, Akatsuka S, Ikeda M, Tada T, Ukita T, Nakamura Y, Nagao J, Sakai Y. Self-expandable metallic stent placement for palliation in gastric outlet obstructions caused by gastric cancer: a comparison with surgical gastrojejunostomy. J Gastroenterol 2005; 40:932-7. [PMID: 16261429 DOI: 10.1007/s00535-005-1651-7] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 05/20/2005] [Indexed: 02/04/2023]
Abstract
BACKGROUND In patients with gastric outlet obstruction (GOO), palliative enteral stenting is a less invasive procedure compared with gastroenterostomy. Most diseases analyzed in previous studies of such stenting were pancreaticobiliary malignancies. METHODS We reviewed the medical records of patients with GOO secondary to gastric cancer who were admitted to our institution between September 1994 and September 2004. The outcome of stent placement for GOO was compared with the outcome in patients who underwent palliative open gastrojejunostomy during the same period. Enrolled patients from both groups displayed symptomatic GOO. Patients with recurrent gastric cancer were excluded from this study. RESULTS Twenty-two patients underwent palliative enteral stenting, and 22 patients were subjected to surgical gastrojejunostomy (bypass). There were no significant differences between the two groups regarding patient baseline characteristics. Technical success and clinical success were obtained in 100% and 77.3%, respectively, of both groups. The operating time was shorter in the stent group (30 vs 118 min; P<0.0001). The time from the procedure to the resumption of food intake was shorter in the stent group than in the bypass group (2 days vs 8 days; P<0.0001). An improvement in performance score after the procedure was observed in both groups (stent group; P=0.0264; bypass group; P=0.0235). No significant differences were observed regarding the possibility of discharge. In patients discharged, the median postoperative hospital stays were 19 days and 28 days (P=0.0558). The median survival periods were 65 days and 90 days. Minor complications were observed in 1 patient in the stent group and in 4 in the bypass group. No mortality or severe complications were observed for either group. CONCLUSIONS Self-expandable metallic stent placement is a safe and efficacious procedure for palliation, with shorter operating time and more prompt restoration of oral intake, compared to surgical alternatives in patients with GOO caused by gastric cancer.
Collapse
Affiliation(s)
- Iruru Maetani
- Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Tran KTC, Smeenk HG, van Eijck CHJ, Kazemier G, Hop WC, Greve JWG, Terpstra OT, Zijlstra JA, Klinkert P, Jeekel H. Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg 2004; 240:738-45. [PMID: 15492552 PMCID: PMC1356476 DOI: 10.1097/01.sla.0000143248.71964.29] [Citation(s) in RCA: 335] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE A prospective randomized multicenter study was performed to assess whether the results of pylorus-preserving pancreaticoduodenectomy (PPPD) equal those of the standard Whipple (SW) operation, especially with respect to duration of surgery, blood loss, hospital stay, delayed gastric emptying (DGE), and survival. SUMMARY BACKGROUND DATA PPPD has been associated with a higher incidence of delayed gastric emptying, resulting in a prolonged period of postoperative nasogastric suctioning. Another criticism of the pylorus-preserving pancreaticoduodenectomy for patients with a malignancy is the radicalness of the resection. On the other hand, PPPD might be associated with a shorter operation time and less blood loss. METHODS A prospective randomized multicenter study was performed in a nonselected series of 170 consecutive patients. All patients with suspicion of pancreatic or periampullary tumor were included and randomized for a SW or a PPPD resection. Data concerning patients' demographics, intraoperative and histologic findings, as well as postoperative mortality, morbidity, and follow-up up to 115 months after discharge, were analyzed. RESULTS There were no significant differences noted in age, sex distribution, tumor localization, and staging. There were no differences in median blood loss and duration of operation between the 2 techniques. DGE was observed equally in the 2 groups. There was only a marginal difference in postoperative weight loss in favor of the standard Whipple procedure. Overall operative mortality was 5.3%. Tumor positive resection margins were found for 12 patients of the SW group and 19 patients of the PPPD group (P < 0.23). Long-term follow-up showed no significant statistical differences in survival between the 2 groups (P < 0.90). CONCLUSIONS The SW and PPPD operations were associated with comparable operation time, blood loss, hospital stay, mortality, morbidity, and incidence of DGE. The overall long-term and disease-free survival was comparable in both groups. Both surgical procedures are equally effective for the treatment of pancreatic and periampullary carcinoma.
Collapse
Affiliation(s)
- Khe T C Tran
- Department of General Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Mack LA, Kaklamanos IG, Livingstone AS, Levi JU, Robinson C, Sleeman D, Franceschi D, Bathe OF. Gastric decompression and enteral feeding through a double-lumen gastrojejunostomy tube improves outcomes after pancreaticoduodenectomy. Ann Surg 2004; 240:845-51. [PMID: 15492567 PMCID: PMC1356491 DOI: 10.1097/01.sla.0000143299.72623.73] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective of this study was to assess the feasibility and safety of inserting a double-lumen gastrojejunostomy tube (GJT) after pancreaticoduodenectomy (PD) and to evaluate associated outcomes. BACKGROUND Gastroparesis is a frequent postoperative event following PD. This often necessitates prolonged gastric decompression and nutritional support. A double-lumen GJT may be particularly useful in this situation: gastric decompression may be achieved through the gastric port without a nasogastric tube; enteral feeding may be administered through the jejunal port. METHODS Thirty-six patients with periampullary tumors were randomized at the time of PD to insertion of GJT or to the routine care of the operating surgeon. Outcomes, including length of stay, complications, and costs, were followed prospectively. RESULTS The 2 groups had similar characteristics. Prolonged gastroparesis occurred in 4 controls (25%) and in none of the patients who had a GJT (P = 0.03). Complication rates were similar in each group. Mean postoperative length of stay was significantly longer in controls compared with patients who had a GJT (15.8 +/- 7.8 days versus 11.5 +/- 2.9 days, respectively; P = 0.01). Hospital charges were 82,151 +/- 56,632 dollars in controls and 52,589 +/- 15,964 dollars in the GJT group (P = 0.036). CONCLUSIONS In patients undergoing PD, insertion of a GJT is safe. Moreover, insertion of a GJT improves average length of stay. At the time of resection of periampullary tumors, GJT insertion should be considered, especially given this is a patient population in which weight loss and cachexia are frequent.
Collapse
Affiliation(s)
- Lloyd A Mack
- Department of Surgery, University of Calgary, Calgary, Canada
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Beecherl EE, Shires GT, Shires GT. Treatment of Post-pancreaticoduodenectomy Complications. ACTA ACUST UNITED AC 2004; 7:365-370. [PMID: 15345207 DOI: 10.1007/s11938-004-0049-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pancreaticoduodenectomy is a complex operation that is becoming more common as treatment for both malignant and benign diseases. While postoperative mortality has improved over the last two decades, morbidity continues to remain high. The improvement in mortality is attributed to better perioperative care, including aggressive early diagnosis of complications and a multidisciplinary approach to their treatment. In addition to a high clinical suspicion for postoperative complications, ready access to state of the art diagnostic radiology and endoscopy are essential for the early and accurate diagnosis of complications. After the diagnosis of a complication is made, the patient should have expertise available in interventional radiology, gastroenterology, and hepatobiliary and pancreatic surgery. Optimal treatment may involve any one of these specialties or an orchestrated effort from them all. The need for a critical mass of expertise in many specialties and subspecialties has prompted the development of new tertiary centers devoted to hepaticopancreaticobiliary (HPB) diseases. These HPB centers are becoming more prevalent in the United States as the value of this subspecialty is becoming more recognized. These HPB centers should continue to show improvements in quality and cost of care in treating complex liver, pancreatic, and biliary diseases that have rapidly evolving treatment options.
Collapse
Affiliation(s)
- Ernest E. Beecherl
- Department of Surgery, Presbyterian Hospital of Dallas, 8200 Walnut Hill Lane, Dallas, Texas 75231 USA.
| | | | | |
Collapse
|
48
|
Maetani I, Ikeda M, Shimura JI, Ukita T, Sakai Y. CURRENT STATE OF SELF-EXPANDABLE METALLIC STENT PLACEMENT FOR GASTRIC OUTLET OBSTRUCTION. Dig Endosc 2004. [DOI: 10.1111/j.1443-1661.2004.00364.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
|
49
|
Riediger H, Makowiec F, Schareck WD, Hopt UT, Adam U. Delayed gastric emptying after pylorus-preserving pancreatoduodenectomy is strongly related to other postoperative complications. J Gastrointest Surg 2004. [PMID: 13129553 DOI: 10.1016/s1091-255x(03)00109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Patients undergoing pylorus-preserving pancreatoduodenenectomy (PPPD) have a risk of up to 50% for developing delayed gastric emptying (DGE) in the early postoperative course. From 1994 to August 2002, a total of 204 patients underwent PPPD for pancreatic or periampullary cancer (50%), chronic pancreatitis (42%), and other indications (8%). Retrocolic end-to-side duodenojejunostomy was performed below the mesocolon. DGE was defined by the inability to tolerate a regular diet after day 10 (DGE10) or day 14 (DGE14) postoperatively, as well as the need for a nasogastric tube at or beyond day 10 (DGE10GT). Postoperative morbidity was 38%, 30-day mortality was 2.9%, and median postoperative length of stay was 15 days. DGE occurred in 14.7% (DGE10), 5.9% (DGE14), and 6.4% (DGE10GT), respectively. After further exclusion of 21 patients (10.3%) with major complications and no possible oral intake (because of death, reoperation, or mechanical ventilation), the frequencies of DGE10, DGE14, and DGE10GT in the remaining group of 183 patients were 9%, 2%, and 2%, respectively. Multivariate analysis revealed postoperative complications (P<0.001), the presence of portalvenous hypertension (P<0.01), and tumors as indications for surgery (P<0.01) as independent risk factors for DGE10. The overall incidence of DGE was low after PPPD. In those patients experiencing DGE, however, other postoperative complications were the most important factor associated with its occurrence.
Collapse
Affiliation(s)
- Hartwig Riediger
- Department of Surgery, University of Freiburg, Freiburg, Germany
| | | | | | | | | |
Collapse
|
50
|
Horstmann O, Markus PM, Ghadimi MB, Becker H. Pylorus preservation has no impact on delayed gastric emptying after pancreatic head resection. Pancreas 2004; 28:69-74. [PMID: 14707733 DOI: 10.1097/00006676-200401000-00011] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Delayed gastric emptying (DGE) has been specifically attributed to pylorus-preserving pancreaticoduodenectomy (PPPD). As PPPD has been shown to be comparable with the classic Kausch-Whipple pancreaticoduodenectomy (KWPD) in terms of oncological radicality, DGE has advanced to be the leading argument for hemigastrectomy in PD. METHODS A prospective, nonrandomized comparison of patients undergoing PPPD (n = 113), KWPD (n = 19), and duodenum-preserving, pancreatic head resection (DPPHR, n = 18) for various diseases was performed. First, groups were analyzed with regard to structural similarity; then, they were compared with special emphasis on DGE and other postoperative complications. Finally, further prognostic factors were sought that had an impact on DGE. RESULTS The PPPD group was comparable with the KWPD group, but not to the DPPHR population. The in-clinic course after DPPHR compared favorably with PPPD as well as KWPD, and, here, no DGE occurred. The overall morbidity rates of PPPD and KWPD were comparable; 1 patient died in hospital (mortality rate, 0.7%). The gastric tube after PPPD and KWPD could be withdrawn at a median of 2 and 3 days, respectively, a liquid diet was started after 4 and 5 days, respectively, and a full diet was tolerated after 10 days each (n.s.). DGE was distributed evenly among PPPD (12%) and KWPD patients (21%, n.s.), and it was noted almost exclusively when other postoperative complications were present (P < 0.0001). No further prognostic factors influencing DGE could be identified. CONCLUSION Pylorus preservation does not increase the frequency of DGE. DGE almost exclusively occurs as a consequence of other postoperative complications. Therefore, DGE should not be used as an argument to advocate hemigastrectomy in PPPD.
Collapse
Affiliation(s)
- Olaf Horstmann
- Department of Surgery, University Clinic, Göttingen, Germany.
| | | | | | | |
Collapse
|