Roux-Y gastrectomy for chronic gastric atony

Karlström, Lars; Kelly, Keith A.

doi:10.1016/0002-9610(89)90418-2

Cited by 54 publications

(32 citation statements)

References 17 publications

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“…Billroth I gastroduodenostomy is the standard reconstruction technique after distal gastrectomy in Japan, whereas Roux-en-Y gastrojejunostomy is now used worldwide for the prevention of alkaline reflux gastritis, esophagitis, dumping syndrome, and carcinogenesis of the gastric remnant [1][2][3]. However, some patients who receive Roux-en-Y gastrojejunostomy suffer from the Roux stasis syndrome [4]; this reportedly occurs in approximately 30% of patients who undergo a Roux-en-Y gastrojejunostomy after distal gastrectomy [5].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopy-assisted uncut Roux-en-Y operation after distal gastrectomy for gastric cancer

et al. 2005

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Kelly [8], reported that this method preserved gastric emptying and prevented the Roux stasis syndrome.In Japan, the uncut Roux operation is not yet considered an alternative method. Moreover, the use of the laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy has not been reported in the English-language literature. We performed 42 laparoscopic uncut Roux-en-Y gastrojejunostomies for gastric carcinoma. Here we describe the technical details and the initial results of our surgical technique. Method Operating-room setupUnder general anesthesia, each patient was placed in the supine position with the legs apart. A 20° head-up tilt was applied in order to prevent the transverse colon or small intestine from visually compromising the operative field. The surgeon stood on the patient's right, with the first assistant on the patient's left and the camera operator between the patient's legs. Surgical techniqueAfter pneumoperitoneum was established using the open technique, five ports were placed and a flexible electrolaparoscope was introduced through the infraumbilical port.The complete uncut Roux-en-Y gastrojejunostomy is illustrated in the schema in Fig. 1. This method is a modified Billroth II operation, which is accomplished by stapling across the afferent limb of the Billroth II gastrojejunostomy in continuity just proximal to the stomach and performing a side-to-side anastomosis for 40 cm between the afferent limb and the efferent limb, which is designated a "Braun enteroenterostomy".

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Section: Introductionmentioning

confidence: 99%

Laparoscopy-assisted uncut Roux-en-Y operation after distal gastrectomy for gastric cancer

et al. 2005

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“…The Roux-en-Y is however, the ideal choice of reconstruction after total gastrectomy [2]. Completion or subtotal gastrectomy with Rouxen-Y gastrojejunostomy has been recommended for treatment of persisting or unresolved DGE [5,6,25].…”

Section: Discussionmentioning

confidence: 99%

An Analysis of Possible Risk Factors Contributing to Delayed Gastric Emptying after Distal Gastrectomy for Gastric Cancer

Sulav¹,

Shi²,

Ahmad³

et al. 2017

J Gastrointest Dig Syst

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Gastric cancer is a worldwide epidemic. The standard and definitive treatment for gastric cancer is surgical resection: gastrectomy. Surgery is a common trigger for gastroparesis. DGE is arguably the most common of the post-gastrectomy syndromes, accounting for 5-20% of all cases. A clear etiology still remains unidentified. The purpose of the study is to analyze the possible risk factors contributing to development of DGE after distal gastrectomy for gastric cancer.A retrospective study of 252 patients, who underwent distal gastrectomy for gastric cancer, was conducted from January 2010 to December 2015. 18 patients developed DGE with an occurrence rate of 7.1%. The incidence of DGE was found to be significantly higher in patients with 1) Gastric outlet obstruction (P=0.031), 2) Roux-en-Y reconstruction surgery (P=0.041), 3) Side to end gastrojejunostomy (P=0.03), 4) Tumor in the lower 1/3 rd (P= 0.027) and 5) Ulcerative lesion (P=0.001). DGE continues to affect a considerable number of patients after gastric surgery. Proper preoperative preparation and postoperative management can considerably reduce the incidence of DGE.

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“…1 Regardless of the aetiology, up to one-third of patients showed no improvement on postsurgical intervention. 29 Gastric electrical stimulation delivering high-frequency/lowenergy stimulation via an implantable device has been employed in patients with refractory symptoms with benefits seen on symptomatology, body weight, requirements for medications and supplemental nutrition and quality of life. 30,31 The exact mechanism underlying the benefit is unknown but myoelectric modulation, modification of sympathovagal activity and thalamic effects have been observed.…”

Section: Discussionmentioning

confidence: 99%

Gastroparesis in pregnancy: case report and literature review

et al. 2011

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Summary: Gastroparesis is a syndrome characterized by delayed gastric emptying in the absence of mechanical obstruction. The most common underlying aetiology is diabetes mellitus; however, many cases are idiopathic. Pregnancy per se is associated with gastrointestinal neuromuscular dysfunction; however, reports of gastroparesis arising during pregnancy are rare. We report a case of severe gastroparesis and proximal small bowel paresis presenting during pregnancy.Keywords: gastroenterology, high-risk pregnancy CASE REPORTA 24-year-old primigravida, at 10 weeks gestation, presented with nausea, vomiting, colicky right lower quadrant pain and an elevated white cell count. There was no history of fevers. She underwent uncomplicated laparoscopic appendicectomy; however, she was found to have congenital malrotation of the bowel, and the appendix, located in the right upper quadrant, was normal on histology. No cause of the right lower quadrant pain was identified.Post appendicectomy, the patient had ongoing symptoms and developed intractable large volume vomitus, initially containing 'old' food, and absence of bowel motions with minimal flatus. Two weeks later the patient presented to the emergency department with ongoing symptoms and 7 kg weight loss (8.1% of initial body weight, body mass index 31.6). The vital signs showed a blood pressure of 110/70 ( postural drop of 20 mmHg in systolic blood pressure), heart rate 96 beats per minute and temperature 37.18C. On examination the patient appeared unwell with clinical signs of dehydration and right lower quadrant abdominal tenderness with abdominal distension. There were no clinical features consistent with an autonomic or peripheral neuropathy. Laboratory tests were notable for the presence of a marked electrolyte disturbance, acute renal impairment with an elevated urea/ creatinine ratio (in keeping with dehydration) and deranged liver function tests (Table 1). The lipase and lactate were normal.The patient was prescribed antiemetic medication (metoclopramide, prochlorperazine and ondansetron), vitamin supplementation (thiamine and multivitamin), intravenous fluid therapy and kept nil by mouth. With hydration there was resolution of the postural drop, normalization of the renal and electrolyte disturbances, and improvement of the liver function tests. There was little change in symptomatology.An abdominal ultrasound showed a normal gallbladder, pancreas, spleen, kidneys and ureters with diffuse fatty infiltration of the liver (likely secondary to rapid weight loss). On day 8, an upper endoscopy performed showed a dilated stomach with a large amount of fluid residue. No focal abnormality was detected. The first and second parts of the duodenum were grossly dilated with an apparent transition point between segments D2 and D3 with no mucosal abnormality visualized. The distal D3 segment appeared normal. Gastric mucosal biopsy was normal. A diagnostic laparoscopy on day 9 revealed a dilated stomach with inflammatory adhesions at the duodenum, thought to be a point of obs...

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Roux-Y gastrectomy for chronic gastric atony

Cited by 54 publications

References 17 publications

Laparoscopy-assisted uncut Roux-en-Y operation after distal gastrectomy for gastric cancer

Laparoscopy-assisted uncut Roux-en-Y operation after distal gastrectomy for gastric cancer

An Analysis of Possible Risk Factors Contributing to Delayed Gastric Emptying after Distal Gastrectomy for Gastric Cancer

Gastroparesis in pregnancy: case report and literature review

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