Surgery of the Stomach and Duodenum
TL;DR: The second edition of Surgery of the Stomach and Duodenum is an extension of the classical first edition; however, each section and chapter has been updated to include all pertinent data that has been brought forth in the intervening seven years.
Abstract: The second edition of Surgery of the Stomach and Duodenum is an extension of the classical first edition. The text maintains its basic format throughout; however, each section and chapter has been updated to include all pertinent data that has been brought forth in the intervening seven years. A number of new contributing authors have been added, bringing the total list to 77; each is an outstanding authority in the area he has been called upon to discuss. The organizational feat of obtaining so august a group to contribute to one text is in itself a noteworthy achievement. I have read this book with a critical view and can only praise it. All areas are covered completely: anatomy, physiology, pathology, roentgen diagnosis, surgical and medical treatment, complications of each, special problems related to pediatric patients, hemorrhage in the aged, perforation, obstruction, operative techniques, and all others. The authors have skillfully
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TL;DR: This review highlights current knowledge about the mechanisms of dumping syndrome and available therapy and offers treatment options for patients with dumping syndrome.
Abstract: Anatomic and physiologic changes introduced by gastric surgery result in clinically significant dumping syndrome in approximately 10% of patients. Dumping is the effect of alteration in the motor functions of the stomach, including disturbances in the gastric reservoir and transporting function. Gastrointestinal hormones play an important role in dumping by mediating responses to surgical resection. Treatment options of dumping syndrome include diet, medications, and surgical revision. Poor nutrition status can be anticipated in patients who fail conservative therapy. Management of refractory dumping syndrome can be a challenge. This review highlights current knowledge about the mechanisms of dumping syndrome and available therapy.
175 citations
TL;DR: It is shown that laparoscopic Nissen fundoplication can be performed safely if the team is well trained and there are no instances of long‐term dysphagia after surgery.
Abstract: Between May 1991 and November 1992, 80 consecutive patients with gastro-oesophageal reflux disease underwent laparoscopic Nissen fundoplication. The technique used was exactly the same as for the conventional open approach. There were no deaths but there were four peroperative complications: one gastric perforation, two pleural perforations and one hepatic laceration. Three conversions to laparotomy were necessary, one because of a defective needle holder and two as a result of left hepatic lobe hypertrophy. The duration of operation ranged from 40 to 300 (median 150) min. The median postoperative stay was 3 days, but increased to 10 days in two patients who developed pulmonary infection. One major postoperative complication (necrosis of the wrap) required a laparotomy on day 8 after operation. No recurrence of heartburn has been observed and there were no instances of long-term dysphagia after surgery. These findings indicate that laparoscopic Nissen fundoplication can be performed safely if the team is well trained.
125 citations
TL;DR: Jejunal pouch formation and restoration of duodenal transit have been suggested for reconstruction after total gastrectomy and their clinical value vary.
Abstract: Background:
Jejunal pouch formation and restoration of duodenal transit have been suggested for reconstruction after total gastrectomy. Opinions about the clinical value vary.
Methods:
The literature was searched for prospective randomized trials comparing reconstructive procedures after total gastrectomy for malignancy. Reports with at least an English or German abstract were included. Immediate results were evaluated in terms of postoperative deaths and complications. Long-term outcome was analysed using trends in bodyweight and quality of life.
Results:
A total of 19 randomized trials including 866 patients was identified. The operative risk of total gastrectomy was low, with a median mortality rate of 0 (range 0–22) per cent, irrespective of the method of reconstruction. Neither gastric substitution nor restoration of duodenal transit was associated with significant procedure-related complications. Results for specific reconstructions varied considerably within and between individual trials. Jejunal pouch reconstruction, but not restoration of duodenal passage, was associated with improved food intake and a tendency for weight gain in the early postoperative months. A favourable perception of quality of life persisted in the long term in some studies.
Conclusion:
Preservation of duodenal transit offers little clinical benefit. Construction of a small-bowel reservoir after total gastrectomy should be considered to improve early postoperative eating capacity, bodyweight and quality of life. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
110 citations
TL;DR: Investigation of the safety and radicality of the pylorus‐preserving gastrectomy procedure in Japan found it to be a safe and effective operation for early gastric cancer.
Abstract: Background:
Pylorus-preserving gastrectomy has been introduced as a function-preserving operation for early gastric cancer in Japan. The aim of this study was to investigate the safety and radicality of the procedure.
Methods:
Between 1995 and 2004, 611 patients with apparent early gastric cancer in the middle third of the stomach had pylorus-preserving gastrectomy. The short-term surgical and long-term oncological outcomes of these operations were assessed.
Results:
The accuracy of preoperative diagnosis of early gastric cancer was 94·3 per cent. Nodal involvement was seen in 62 patients (10·1 per cent). There were no postoperative deaths. Complications developed in 102 patients (16·7 per cent). Major complications, such as leakage and abscess, were observed in 19 (3·1 per cent). The most common complication was gastric stasis, occurring in 49 (8·0 per cent). The overall 5-year survival rate in patients with early gastric cancer was 96·3 per cent.
Conclusion:
Pylorus-preserving gastrectomy is a safe operation with an excellent prognosis in patients with early gastric cancer. It is recommended as the standard procedure for early gastric cancer in the middle third of the stomach. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
86 citations
TL;DR: This study aimed to evaluate the results of emergency gastrectomy and to examine the factors that predict the operative outcome.
Abstract: Background
Emergency gastric resection for complicated peptic ulcer and gastric cancer is a major challenge for general surgeons. This study aimed to evaluate the results of emergency gastrectomy and to examine the factors that predict the operative outcome.
Methods
A total of 82 consecutive patients who underwent emergency gastrectomy were studied. The following variables were assessed: pathology, mortality rate, morbidity, reasons for reoperation and factors related to the outcome.
Results
There were 64 men and 18 women with a median age of 62 (range 30–90) years. The indications were bleeding and perforated gastric or duodenal ulcers in 45 and 20 patients respectively, and bleeding and perforated gastric tumours in seven and ten patients respectively. The overall mortality rate was 17 per cent (n = 14). The complication rate was 63 per cent and 11 patients (13 per cent) required reoperation. By multivariate analysis, age greater than 65 years and blood haemoglobin level less than 10 g/dl on admission were predictive of complications after emergency gastrectomy. Postoperative pulmonary and cardiac complications and hypotension on admission were independent risk factors associated with operative death.
Conclusion
Age more than 65 years, haemoglobin level less than 10 g/dl and hypotension on admission were associated with a poor outcome after emergency gastrectomy. The operative result was not affected by the underlying gastric pathology. © 2000 British Journal of Surgery Society Ltd
76 citations