Fat absorption after total gastrectomy in rats submitted to Roux-en-Y or Rosanov-like double-transit technique

Abstract

Purpose: Steatorrhea is one of the most common complications in reconstruction after total gastrectomy. Many reconstruction techniques after total gastrectomy have been developed in order to avoid these undesirable effects, but each one of them has some inconvenience. In this experiment, a modified Rosanov technique that keeps duodenal transit, evaluation of fat absorption after gastrectomy was tested. Methods: Three groups of rats with the same characteristics were used. Total gastrectomy was performed in two groups: one was operated on and transit was reestablished by the Roux-en-Y technique (group Y), while the other was submitted to the modified Rosanov technique (group R). Following surgery, a handmade hyper fatty diet (11% of fat) was offered. A third group (control -group C) was not operated but was submitted to the same conditions of the other groups, and used for reference steatocrit values. The animals underwent laparotomy 14 days after surgery and had their feces collected from cecum to determine their steatocrit by analysis of their values. Results: Steatocrit values for groups R and C (mean 5.16% and 4.15% respectively) were similar (p > 0.1), while group Y had significantly higher values (mean = 28.18%, p = 0.0001 -p < 0,05). This was attributed to the fact that group R animals had their duodenal transit patent, decreasing the complications expected in the Roux-en-Y reconstruction. Conclusions: Steatorrhea in the modified Rosanov technique was similar to the control group, while Roux-en-Y reconstruction presented higher steatorrhea and fat malabsorption. Key words: Gastrectomy. Postgastrectomy Syndromes. Anastomosis, Roux-en-Y. Steatorrhea. Diarrhea. RESUMOObjetivo: Uma das principais complicações tardias da gastrectomia total com reconstrução de trânsito excluindo duodeno é a esteatorréia. Várias técnicas de reconstrução após gastrectomia total foram descritas para que se pudesse evitar esses efeitos indesejáveis, mas cada uma apresentou seus inconvenientes. Nesse estudo foi avaliada a técnica descrita por Rosanov com uma pequena modificação, que mantém o trânsito através do duodeno, para avaliar a absorção de gorduras. Métodos: Foram utilizados três grupos de ratos Wistar machos, com peso e características semelhante. Dois grupos foram submetidos à gastrectomia total: o primeiro teve sua reconstrução com técnica de Y de Roux (grupo Y), e o segundo com Rosanov modificado (grupo R). Após a cirurgia, foi introduzida dieta com teor de gorduras conhecido (11%). Um terceiro grupo (grupo C) esteve sob mesmas condições dos outros animais, sem ter sido submetido à cirurgia, e foi utilizado como grupo controle para o esteatócrito. Após 14 dias, antes de serem sacrificados, foram submetidos a laparotomia para coleta de fezes do ceco e dosagem de esteatócrito. Os valores de esteatócrito foram analisados estatisticamente pelo método de Kruskal-Wallis. Resultados: O esteatócrito dos grupos R (média = 5,16%) e C (média = 4,15%) foram semelhantes (p > 0,1), enquanto o grupo Y teve valores significativame...

Técnica de Rosanov modificada na reconstrução do trato digestivo após gastrectomia total

“…Experimental research developed in Brazil by Seva-Pereira et al 17 in rats, using steatocrit as simple method for measuring the fat in the stool after total gastrectomy with reconstruction of the transit with modified technique Rosanov compared with Roux-en-Y classical; control animals showed lower levels of steatorrhea with Rosanov technique, very similar to those of non-operated animals.…”

Effects of the partial gastrectomy associated to anterior truncal vagotomy in the metabolism of the iron in rats

“…The deficiency of iron occurs in up to 70% of the patients submitted to Billroth II gastrectomy, providing a smaller gastric capacity and absence of the duodenum in the intestinal transit, reducing the alimentary use as the absorption of nutrients 4,5,6,10,13 .…”

“…Therefore, the gastrectomized rat is an excellent experimental model for studies of the metabolism of iron, as only 2 (two) months after the surgery were enough to modify statistically the haematocrit and the haemoglobin among the groups, being smaller in the animals of the GXT group 4,5,6,19,20 .…”

“…The gastrintestinal transit after the partial gastrectomy is rebuilt through anastomosis with the duodenum (Billroth I-BI) or the jejunum (Billroth II-BII). The partial or total resection of the stomach includes the removal of the whole antrum and consequent decrease in the production of hydrochloric acid (HCl) and of the intrinsic factor, then the digestive function of the stomach and duodenum and the absorption processes are alterered [3][4][5] . Therefore, the absorption of the iron can be harmed after the gastrectomy, because its needs the hydrochloric acid to be better absorbed in the ferrous form in the duodenum 6 .…”

Complicações pós-operatórias após gastrectomia total no câncer gástrico: análise de 300 doentes

“…Are cited: dumping in about 2% to 8%, diarrhea and malabsorption in 3% to 10%. Recurrence of cancer at the esophagus-jejunal anastomosis, because inadequate surgical margins is reported to occur in 1% to 4% of cases 3,4,6,19,28,31 . The overall mortality of total gastrectomy for gastric cancer ranges from 2% to 15%, secondary to surgery, and up to 20% if included other complications not directly related to surgery.…”