Effect of biliary reconstruction procedures on gastric acid secretion

The postoperative results of pylorus-preserving gastrectomy (PPG) for gastric ulcer performed in 134 patients during the past 25 years (mean postoperative period, 16.6 years) were studied. The incidence of postoperative complications was low. Dumping syndrome occurred in only 4.4% and 0% of cases as assessed by questionnaire and interview, respectively. Four (5.4%) of 74 patients available for this study had ulcer recurrence. In one of these four patients concurrent gastroduodenal ulcer was suspected from preoperative gastric analysis. The site of recurrence was found in all cases to be the remnant antral gland area along the greater curvature between the proper gastric gland area and the duodenum. Basal and maximal acid outputs at the time of relapse were significantly higher in patients with recurrence than in patients without recurrence. The fasting and postprandial serum gastrin levels were high in one patient with recurrence, whose antrum was preserved as long as 3 cm proximal to the pyloric ring ; this was longer than that described in our original method of PPG. In two other recurrent cases the serum gastrin levels were not different from those in norecurrent cases. Immunohistochemical examination of the residual antrum showed no increase in the G-cell density in patients either with or without recurrence. These results suggest that the long-term quality of life of patients treated with PPG remains favorable. Recurrence rate can be further reduced if PPG is strictly indicated for gastric ulcer only and carried out by meticulous surgical techniques. In the pathogenesis of the ulcer recurrence the role of gastrin release from the residual antral mucosa seems to be limited. pylorus-preserving gastrectomy ; long-term follow-up ; postoperative ulcer recurrence Since conventional gastrectomy involves pyloric resection, postoperative sequelae, such as dumping syndrome and other disorders of digestion and absorption may occur as a result of rapid gastric emptying. To minimize these complications, we have performed pylorus-preserving gastrectomy (PPG) for

show abstract

“…For test meal loading, 300 gr of porridge and one egg were used, as reported previously (Sato et al 1982). …”

Section: Questionnaire and Interviewmentioning

confidence: 99%

Long-Term Results of Pylorus-Preserving Gastrectomy for Gastric Ulcer.

Sasaki

Fukushima

Naitö

et al. 1992

Tohoku J. Exp. Med.

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, peptic ulceration can develop after this operation in some 7-13% of cases [12,16,20,23]. For this reason some have suggested an interposed loop of jejunum between the bile ducts and the duodenum [17][18][19]24], but this approach has not been generally adopted, the advent of the new histamine Hz antagonists introducing a method of therapy for those who develop peptic ulceration and indeed these drugs could be used prophylactically for patients shown to have a high acid output pre-operatively [12]. Patients with proven duodenal ulceration should be considered for a definitive ulcer operation at the time of biliary repair.…”

Section: Results and Conclusionmentioning

confidence: 99%

Surgical approaches to the left hepatic duct

Blumgart¹

1987

Langenbecks Arch Chiv

View full text Add to dashboard Cite

“…Biliary-duodenal diversion using an isolated jejunal loop to facilitate biliary drainage and prevent ascending cholangitis has been repeatedly described [21,[25][26][27][28][29][30], having demonstrated its utility in biliary [31,32], pancreatic, and combined biliary and pancreatic diversion [32]. This diversion requires only one more intestinal anastomosis, which is easily executed.…”

Section: Discussionmentioning

confidence: 99%

“…This diversion requires only one more intestinal anastomosis, which is easily executed. It offers the advantage of allowing bile juice to empty into the duodenum, avoiding reflux of enteric contents, which does not occur at this level, and reducing the possibility of gastroduodenal ulcer [31,33] by not changing the bile salt and acid balance [28,29]. Although the need to empty bile juice into the duodenum can be debated, if the procedure is not more difficult, as shown by our experience, the surgeon should remember that one of the tenets of surgical practice is to respect normal human physiology as much as possible.…”

Section: Discussionmentioning

confidence: 99%

Choledochal cyst resection and reconstruction by biliary‐jejuno‐duodenal diversion

et al. 1989

View full text Add to dashboard Cite

From January, 1983 to December, 1986, a total of 9 patients, ranging in age from 2 years and 4 months to 36 years, with choledochal cysts were treated. Symptoms were right upper quadrant pain (n = 9), ascending cholangitis (n = 7), and jaundice (n = 6). A right upper quadrant mass was palpable in 7 patients and gallstones were present in 5 patients. Diagnosis was established by intravenous cholangiogram and ultrasound. The operation was performed through a right subcostal laparotomy. The choledochal cyst diameter ranged from 4.5 to 7 cm. The cyst and the common duct were dissected from the hepatic artery and portal vein. The choledochus was sectioned above the duodenum and the distal end was closed by interrupted sutures. The common duct was divided below the hepatic confluence and the diameter enlarged by longitudinal section of the left hepatic duct. A 30-cm-long segment of isolated jejunum was passed through the transverse mesocolon to the right of the middle colic vessels and behind the duodenum and then interposed between the hepatic confluence and the second portion of the duodenum. Biliary-jejunal anastomosis was performed in 1 layer with interrupted absorbable stitches. No mortality or serious complications occurred during follow-up (1-4 years). No cholangitis, fever, or pain have developed. All patients were studied postoperatively by biochemical test, ultrasonography, Tc 99m DISIDA, and barium meal swallow. Good liver function and biliary excretion, and absence of duodeno-jejuno biliary reflux were demonstrated.

show abstract

Effect of biliary reconstruction procedures on gastric acid secretion

Cited by 15 publications

References 5 publications

Long-Term Results of Pylorus-Preserving Gastrectomy for Gastric Ulcer.

Long-Term Results of Pylorus-Preserving Gastrectomy for Gastric Ulcer.

Surgical approaches to the left hepatic duct

Choledochal cyst resection and reconstruction by biliary‐jejuno‐duodenal diversion

Contact Info

Product

Resources

About