Sustaining good nutrition and preventing postgastrectomy syndrome are important for increasing the quality of life after distal gastrectomy. Many surgeons have proposed surgical methods designed to enhance long-term patient quality of life. An immediate, safe method based on current physiologic reconstructive principles shown to reduce postoperative patient complaints is presented. A reconstructive method using a modified interpositioned double-jejunal pouch after distal gastrectomy in 18 cancer patients was reviewed. This method uses a triangulating stapling technique with wide end-to-side anastomosis between the residual stomach and the pouch. In all patients, the anastomosis site was without leakage or stenosis, and there were no episodes of severe reflux esophagitis, residual gastritis, or dumping syndrome. The mean pooling rate was 44.2%, and emptying half-time was 73.0 minutes. After 2 years the body weight was 91.3% of the preoperative weight, the food volume was 89.2% of normal intake, and meal frequency was 3.0 per day. This method of reconstruction is useful for immediate and safe creation of a wide anastomosis between the residual stomach and the double-jejunal pouch after distal gastrectomy and in the prevention of esophagitis and residual gastritis.
A 75-year-old man was admitted for the treatment of obstructive jaundice in July 1996 and was subsequently diagnosed as having a bile duct carcinoma.The patient underwent a radical bile duct resection with portal resection in August 1996. Pathological diagnosis revealed a moderately differentiat ed tubular adenocarcinoma, stage III. The left cervical lymph nodes gradually became swollen, and a tumorectomy was performed 10 months later. Pathological examination revealed a metastases of the bile duct carcinoma. The patient underwent two subsequent tumorectomies for left axillary lymph node swelling, 24 and 32 months later. The surgical specimens were identified as pathologically identical metastases of the bile duct carcinoma. The patient remains disease-free 7 years after undergoing the initial bile duct resection. The prognosis of patients with advanced bile duct carcinoma, especially those with lymph node metastases, is considered to be poor. Herein, we report the rare case of a 7-year long term survivor who received 3 tumorectomies for distant lymph node metastases after an initial operation for advanced middle bile duct carcinoma.
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