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The Stomach
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
Radical gastrectomies include radical subtotal (distal or proximal) and radical total gastrectomy. Distal gastric lesions are more common and permit the easiest decision. The approach is radical distal subtotal gastrectomy. The resection should include 2 cm of the first part of the duodenum, the whole lesser curvature almost to the esophagogastric junction, and the greater curvature to the level of the lower short gastric vessel. It should also include the lesser and greater omentums and the peripyloric lymph nodes. In addition, the left gastric artery is to be ligated at its origin, and the celiac lymph nodes removed. The reconstruction is best accomplished by a Billroth II, antecolic, isoprystaltic gastrojejunostomy. Reconstruction with Billroth I should not be attempted because of the high local-regional recurrence rate in the stomach bed which can be as high as 50% clinically and even higher at autopsy.10-13 Such recurrence may lead to obstruction of the gastroduodenal anastomosis.
Dyspepsia
Published in Andrew Stevens, James Raftery, Jonathan Mant, Sue Simpson, Health Care Needs Assessment, 2018
Brendan C. Delaney, Paul Moayyedi
The success of H. pylori eradication therapy in preventing long-term recurrence of peptic ulcer disease means that ulcer surgery is now rarely performed. Operations that have been recommended include an antrectomy with a gastro-duodenal anastomosis (Billroth I), an antrectomy with gastro-jejunal anastomosis (Billroth II), a vagotomy and pyloroplasty or a highly selective vagotomy.
B
Published in Anton Sebastian, A Dictionary of the History of Medicine, 2018
Billroth Operation II (Syn. Billroth II anastomosis) Resection of the pylorus with the greater part of the lesser curvature of the stomach, closure of the cut ends of the duodenum and stomach, followed by a gastrojejunostomy.
Novel elbow basket mechanical lithotripter for large common bile duct stone removal
Published in Postgraduate Medicine, 2022
Huahui Zhang, Ying Fang, Jian Huang, Fengdong Li, Xiangrong Qin, Jin Huang
Data were collected from June 2016 to September 2021 at the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University. The inclusion criteria for the study were as follows: 1) patients with a maximum stone diameter of no less than 10 mm were confirmed by computerized tomography or magnetic resonance imaging (Figure 1). 2) patients who underwent ML using elbow basket mechanical lithotripter (EBML) or CBML. The exclusion criteria were as follows: 1) patients who had a history of endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilation (EPBD). 2) patients had a surgically altered anatomy (Billroth II or Roux-en-Y). 3) age < 18 years; and 4) pregnant woman. A total of 139 patients were enrolled in the retrospective study. Sixty-eight patients underwent ML by CBML, and the remaining patients underwent ML by EBML. All patients had no contradiction for ERCP and gave written informed consent before ERCP. This study was approved by the Ethics Committee of the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University.
Continuous Jejunal Pouch and Residual Stomach Anastomosis Combined with Jejunal Lateral Anastomosis: An Improved Method of Gastrointestinal Reconstruction following Distal Gastrectomy
Published in Journal of Investigative Surgery, 2022
JiaQing Gong, Bin Wang, JunQing Wang, YunMing Li, YongKuan Cao, Wei Li, Min Shang, Ling Huang
Although Billroth II is a simple procedure that maintains jejunal continuity, the large amount of alkaline intestinal fluid may freely flow back into the stomach cavity, which is the biggest drawback of this surgical technique, and may cause many consequences such as reflux gastritis and anastomotic ulcer.14,15 Roux-en-Y reconstruction is a relatively complicated procedure; however, it overcomes the problem of alkaline intestinal reflux. Moreover, Roux-en-Y reconstruction also interrupts jejunal continuity, which may cause many intractable long-term complications, such as anastomotic ulcer bleeding.4 Our innovative digestive tract reconstruction, Contin-L procedure, successfully discarded the deficiencies of both Billroth II and Roux-en-Y procedures. Moreover, it combined the advantages of both surgical methods, thereby significantly reducing surgical complications.
Nasobiliary drainage can reduce the incidence of post-ERCP pancreatitis after papillary large balloon dilation plus endoscopic biliary sphincterotomy: a randomized controlled trial
Published in Scandinavian Journal of Gastroenterology, 2018
Qiang Huang, Feng Shao, Chen Wang, Wei Qi, Lu Jun Qiu, Zheng Liu
The eligibility criteria were as follows: patients with visualized bile duct stones larger than 12 mm in maximum diameter, and patients with normal serum amylase levels prior to ERCP. The presence of CBD stones was confirmed using magnetic resonance imaging (MRI). The maximum diameters of the CBD stones were measured using ultrasonography, computed tomography (CT), or MRI. The exclusion criteria were as follows: (a) an age younger than 18 years or older than 80 years, (b) the inability to provide informed consent, (c) biliary stenosis, (d) concomitant acute pancreatitis, (e) concomitant acute cholangitis, (f) prior Billroth II surgery or Roux-en-Y reconstruction, (g) history of a previous ERCP, (h) intrahepatic stones, and (i) a bleeding tendency.