Reconstructive procedure after distal gastrectomy for gastric cancer that best prevents duodenogastroesophageal reflux

Fukuhara, Kenzo; Osugi, Harushi; Takada, Nobuyasu; Takemura, Masashi; Higashino, Masayuki; Kinoshita, Hiroaki

doi:10.1007/s00268-002-6363-z

Cited by 109 publications

(90 citation statements)

References 28 publications

(15 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, the incidence of internal hernia after laparoscopic distal gastrectomy was quiet low. Because of high rates of remnant gastritis after B-I reconstruction, R-Y reconstruction has gradually gained favor for use and has been one of the standard methods of reconstruction after laparoscopic distal gastrectomy [4][5][6].…”

Section: Resultsmentioning

confidence: 99%

Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer

et al. 2013

View full text Add to dashboard Cite

Background To decrease the incidence of internal hernia after laparoscopic Roux-en-Y gastric bypass, recent recommendations indicated closure of mesenteric defects and Petersen's defect. Laparoscopic distal gastrectomy for gastric cancer is used increasingly, so the incidence of Petersen's hernia can also increase, but the trend has not been studied. Methods This study retrospectively reviewed 358 consecutive patients who underwent laparoscopic distal gastrectomy for gastric cancer at one institution, with antecolic Roux-en-Y (RY) reconstruction. Results Petersen's hernia occurred in 6 (2.2 %) of 268 patients whose Petersen's defect was not closed by a mean of 351 days after surgery. All the patients underwent reoperation with reduction and repair of the hernia except the first case. In 90 subsequent cases, with closure of the Petersen's defect, internal hernias did not occur (0/90 cases; p = 0.06). Focusing on the totally laparoscopic procedure, Petersen's hernia occurred in 2 (5.1 %) of 39 patients, whereas in 81 subsequent cases, with closure of Petersen's defect, internal hernias did not occur (0/81 cases; p = 0.03). Conclusions Based on the recent recommendations for bariatric surgery, closure of this potential hernia defect is necessary after laparoscopic distal gastrectomy with R-Y reconstruction for gastric cancer.

show abstract

Section: Resultsmentioning

confidence: 99%

Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Roux-en-Y reconstruction results in a lower frequency of remnant or reflux gastritis [1,2] and a lower possibility of remnant gastric cancer [3], and anastomotic leakage is rare. In addition, a Roux-en-Y anastomosis potentially prevents obstruction of the dietary route caused by recurrence around the pylorus and has a lower possibility of anastomotic leakage than other reconstruction methods [4].…”

Section: Introductionmentioning

confidence: 99%

The flow angle beneath the gastrojejunostomy predicts delayed gastric emptying in Roux-en-Y reconstruction after distal gastrectomy

et al. 2011

View full text Add to dashboard Cite

Background Delayed gastric emptying without mechanical obstruction after Roux-en-Y reconstruction has been defined as Roux stasis syndrome. It occurs in 10-30% of patients after such reconstruction. So far, the cause of this stasis has not been completely identified. This study aimed to reduce Roux stasis using surgical techniques. Methods From November 2007 to October 2010, we performed 101 distal gastrectomies with Roux-en-Y reconstruction. All the gastrojejunostomies were performed with end-to-end anastomoses. Roux stasis was analyzed with respect to tumor location, extent of the dissection, tumor progression, operation time, antecolic/retrocolic reconstruction, and the shape of the gastrojejunostomy. The shape of the gastrojejunostomy was evaluated by contrast gastroradiography 4 days after the operation. Results Roux stasis syndrome was observed in 17 of the 101 patients. There was no relationship between the extent of the dissection, tumor progression, or operation time and the occurrence of Roux stasis. There was no difference in the incidence of Roux stasis between antecolic and retrocolic reconstructions. However, the group that displayed a straight anastomotic shape on contrast radiography demonstrated an apparently lower incidence of Roux stasis (p = 0.0003). In addition, Roux-en-Y reconstruction following gastric cancer was more frequently followed by Roux stasis in the antrum than in the midstomach (p = 0.0036). Cases of Roux stasis occurred 11.8 days after surgery on average and resolved within 2 weeks on average. Conclusions Our findings demonstrate the substantial benefits of a straight anastomosis of the gastrojejunostomy for the prevention of Roux stasis syndrome.

show abstract

“…Reflux of duodenal contents into the stomach caused so called "spurious proliferation" in the gastric foveola area (pseudohyperplasia fovealis) as a result of chronic inflammation of the stomach (11). As some sources demonstrate (4,8,12), the type of procedure conducted as well as exposure time may influence morphological changes of the stomach mucosa while in contact with bile. It was proved (2, 7, 11) that a BII-type distal gastroenterostomy increases the risk of stomach cancer, while the smallest changes occur after Roux-en-Y gastric bypass surgery, considered by some as an anti-reflux procedure.…”

Section: Discussionmentioning

confidence: 99%

“…These procedures can lead to inflammatory lesions of the mucosa, atrophic and inflammatory changes, and cellular metaplasia (1)(2)(3)(4)(5). Some sources even consider these changes to be premalignant lesions (6,7).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Morphological Changes in the Stomach Mucosa of Rats Caused by Endogenous Bile Acids

Rudnicki¹,

Мазур

Slusarczyk

et al. 2007

Polish Journal of Surgery

View full text Add to dashboard Cite

"Bile reflux" is a common term to denote a process of placing duodenal contents in the stomach and/or lower oesophagus. It is most often associated with functional or organic failure of the pylorus and is a not uncommon postoperative condition after pyloric section, resection or by-passing. Gastrotoxicity of the replaced small intestinal mixture leading to lesions in gastric mucosal barrier, is caused by an increased ability to reabsorb hydrogen ions along with migration of blood proteins and electrolytes towards lumen of the stomach. Consequently, histamine secretion becomes increased, leading to inflammatory and haemorrhagic changes or ulcer niches. The aim of the study was to demonstrate histological and microscopic changes in the gastric mucosa following reflux and to determine if long-term exposure to refluxed duodenal contents will produce tumorous changes in the organs tested. Material and methods. The study consisted of 25 mature female Wistar rats weighing 180-200 g. Bile reflux to the stomach was produced experimentally by surgical drainage. Final evaluation was performed after 55 weeks. Results. Findings were as follows: gastric changes were noted in basal and parietal cells, no tumorous foci were found in histological samples. Slight morphological changes can be caused by short periods of gastric mucosa exposure to the gastrotoxic small intestinal mixture. Conclusions. Endogenous bile acids cause morphological changes in the stomach mucosa of rats. In particular, these changes affect the ultrastructure of basal and parietal cells. No neoplastic foci were found in the examined organs.

show abstract

Reconstructive procedure after distal gastrectomy for gastric cancer that best prevents duodenogastroesophageal reflux

Cited by 109 publications

References 28 publications

Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer

Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer

The flow angle beneath the gastrojejunostomy predicts delayed gastric emptying in Roux-en-Y reconstruction after distal gastrectomy

Morphological Changes in the Stomach Mucosa of Rats Caused by Endogenous Bile Acids

Contact Info

Product

Resources

About