B II-Y-Roux-Anastomose ? Resektionsverfahren der Wahl bei der komplizierten Ulcuskrankheit?

SummaryBackground: Ulcers at the gastrojejunostomy site are a common problem after gastric surgery. Their postoperative development seems to be associated with Helicobacter pylori-related gastritis or abuse of nicotine, alcohol or non-steroidal anti-inflammatory drugs (NSAIDs), but is also dependent on the choice of surgical method (Roux-en-Y or B-II gastric bypass). Patients and Methods: This study evaluated the follow-up of 1,908 patients over a period of 5 years (January 2006 to December 2010). In 1,861 cases, we performed a Roux-en-Y gastric bypass, and in 47 cases a B-II gastric bypass. Results: All patients (n = 407) with symptoms such as dysphagia, reflux, nausea, vomiting or epigastric pain underwent gastroscopy. In 52 cases, ulcers were found at the gastrojejunostomy site. Of these patients, 39 (75%; p < 0.0001) had consumed alcohol, nicotine or NSAIDs; in 14 patients (27%; p < 0.0001) we detected H. pylori-related gastritis. A total of 2.4% of the patients after Roux-en-Y gastric bypass (45/1,861) and 14.9% of the patients after B-II gastric bypass (7/47) developed ulcers at the gastroenteral junction. The difference is clearly significant (Fisher's exact test, p = 0.0002). Furthermore, there were signi ficant differences regarding the recurrence rate: 86% of the B-II gastric bypass group and 13.3% of the Roux-en-Y gastric bypass group needed to be treated several times. Conclusions: Every patient needs to be informed preoperatively that there is a markedly increased risk of ulcers at the gastroenteral junction, particularly if the patient cannot avoid potential risk factors (nicotine, alcohol, NSAIDs). Preoperative gastroscopy with H. pylori testing and subsequent eradication can also reduce the risk of ulcers. An increased incidence of peptic ulcers after B-II gastric bypass was noted. All of these patients were converted to Roux-en-Y.

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Calidad De Vida Relacionada Con Salud: Instrumentos De Medición Para Valoración De Resultados en Cirugía Digestiva Alta

Urrutia

Otzen

2014

Rev Chil Cir

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Health-related quality of life. Measurement tools to assessing upper gastrointestinal surgery outcomes Background: Since a while, clinicians and surgeons recently have recognized the desirability of Health-related quality of life (HRQOL) measure to inform their patients, even health authorities in respect of decision making in health and as a variable to be considered in clinical research. For this, there are multiple questionnaires (including self-administered) that are available for measuring this construct. In the field of upper gastrointestinal surgery, there are tools that have been generated and validated for this purpose (some of them generals and other specifics). The aim of this article is to describe specific measurement instruments to assess HRQOL in upper gastrointestinal surgery. Material and Methods: A search on engines Altavista, Google and Yahoo, in Ixquick and Copérnico metasearch and in the database "Documents in Information Science" (DoIS) was performed. The search strategy used the terms "Quality of Life", "Health-related quality of life", "HRQOL", "Outcome Assessment (Health Care)", "upper gastrointestinal surgery" and "digestive surgery". After locating articles, these were evaluated and a summary document of collected information was developed. Results: The search performed gave 23 instruments: related with upper gastrointestinal benign disease (10), with obesity and bariatric surgery (4), and related with digestive neoplasms (9). Conclusion: There is an interesting variety of instruments to measure HRQOL in upper gastrointestinal surgery. Knowing is a user support to both the development of everyday surgical practice, as for decision-making in health and as measurement instruments in clinical research.

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B II-Y-Roux-Anastomose ? Resektionsverfahren der Wahl bei der komplizierten Ulcuskrankheit?

Cited by 3 publications

References 7 publications

Gutartige Erkrankungen von Magen und Duodenum

Gutartige Erkrankungen von Magen und Duodenum

Two Important Criteria for Reducing the Risk of Postoperative Ulcers at the Gastrojejunostomy Site after Gastric Bypass: Patient Compliance and Type of Gastric Bypass

Calidad De Vida Relacionada Con Salud: Instrumentos De Medición Para Valoración De Resultados en Cirugía Digestiva Alta

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