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Dysphagia Six Weeks Following Accidental Corrosive Ingestion
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Vikram Kate, R. Kalayarasan, N. Ananthakrishnan
The feasibility of laparoscopic Billroth I gastrectomy and laparoscopic colon bypass have been reported in the literature. However, these procedures, especially colonic bypass, is technically challenging, and a small technical error can have a devastating effect on the viability of colon conduit. Hence, minimally invasive approaches should be restricted to centers with extensive experience in advanced laparoscopic procedures. An algorithmic approach to the surgical management of corrosive esophageal stricture is depicted in Figure 3.1. In addition to the surgical management, patients with a history of ingestion with suicidal intention need a comprehensive psychological evaluation and appropriate treatment to prevent future suicidal attempts.
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.
Comparison of Quality of Life and Nutritional Status of Between Roux-en-Y and Billroth-I Reconstruction After Distal Gastrectomy: A Systematic Review and Meta-Analysis
Published in Nutrition and Cancer, 2020
Nannan Du, Manman Chen, Zefeng Shen, Shengnan Li, Ping Chen, Parishit A. Khadaroo, Danyi Mao, Lihu Gu
Billroth-I (B-I) reconstruction has commonly been performed after distal gastrectomy because of technical simplicity and the physiological intestinal continuity. However, in recent decades, many surgeons have preferred Roux-en-Y (R-Y) reconstruction after distal gastrectomy, because B-I reconstruction has many postoperative complications, including remnant gastritis, reflux oesophagitis (5). A recent meta-analysis of 23 studies showed that B-I was the best option in terms of postoperative complications, while R-Y was the most effective anastomosis for reducing the incidence of bile reflux, gastritis, and reflux esophagitis in laparoscopic distal gastrectomy (6). Consequently, some scholars investigated clinical outcomes and QoL according to types of reconstruction following distal gastrectomy (7,8).
Three-Port Versus Five-Port Laparoscopic Distal Gastrectomy for Early Gastric Cancer Patients: A Propensity Score Matched Case-Control Study
Published in Journal of Investigative Surgery, 2018
Since March 2010, 1,115 patients preoperatively diagnosed with gastric cancer underwent gastrectomy at the Department of Surgery at Haeundae Paik Hospital, Inje University College of Medicine, Korea. For EGC, we performed laparoscopic assisted distal gastrectomy (LADG) until March 2013. We then performed FP-LDG using five ports until October 2015, when TP-LDG was introduced. The indications of operative methods, either FP-LDG or TP-LDG, were not different. The difference for the selection of procedure was just dependent on when the operation was conducted. All patients who underwent Billroth-I and Roux-en-Y gastrojejunostomy reconstruction were excluded, because the number of these patients were small compared to the number of the patients who underwent Billroth-II reconstruction during study period. There were no cases of conversion to FP-LDG or open surgery, so that no one was excluded for conversion.
The Impact of Postoperative Enteral Immunonutrition on Postoperative Complications and Survival in Gastric Cancer Patients – Randomized Clinical Trial
Published in Nutrition and Cancer, 2018
Lucyna Scislo, Radoslaw Pach, Anna Nowak, Elzbieta Walewska, Malgorzata Gadek, Philip Brandt, Grazyna Puto, Antoni M. Szczepanik, Jan Kulig
The study involved a group of gastric cancer patients who had undergone a surgical resection in a single institution. In majority of cases (76 patients), total gastrectomy with Roux-en-Y reconstruction was performed. Circular stapler was used for oesophago-jejunal anastomosis. A total of 22 patients underwent subtotal gastric resection: 7 with Billroth I and 15 with Billroth II reconstruction. In the postoperative period, all the patients in the examined group received only enteral nutrition. Inclusion criteria were the diagnosis of gastric cancer, planned elective gastrectomy, normal nutritional status, or mild to moderate malnutrition. Patients with severe malnutrition who required parenteral nutrition were excluded. The nutritional status was assessed according to national guidelines (14). Patients assessed as mild malnourished had up to 10% weight loss, albumin concentration 30–35 g/l, total lymphocyte count (TLC) 1,200–1,500, and patients moderately malnourished had 11–20% weight loss, albumin concentration 24–29 g/l, TLC 800–1199.