Gastrointestinal Cancer and Complementary Therapies
Mary J. Marian, Gerard E. Mullin in Integrating Nutrition Into Practice, 2017
Treatment involves the use of chemotherapy, radiation, targeted therapy, and surgery. Classic nutrition-related side effects occurring with chemotherapy and targeted therapy include nausea, vomiting, anorexia, diarrhea, mucositis, and altered taste. Radiation therapy may cause abdominal pain and discomfort, nausea, vomiting, urinary and bladder changes, diarrhea, changes in appetite, anorexia, and fatigue, while surgical therapy may alter digestion and absorption through the removal of portions of the stomach and small intestine. Typical surgical resections include gastroduodenostomy (Bill Roth I), gastrojejunostomy (Bill Roth II), partial gastric resection, and Roux-en-Y (Sah et al., 2009). If surgical reconstruction is planned, surgeons typically do not favor feeding tube placement prior to surgery. Enteral feeding tubes are on average placed during the surgical procedure for postsurgical nutrition support; however, this may be associated with increased postsurgical complications in relation to surgical site infections and increased length of stay (Patel et al., 2013), consequently J tube placement should be considered on an individual basis.
Pyloric atresia and prepyloric antral diaphragm
Prem Puri in Newborn Surgery, 2017
Depending on the type of pyloric obstruction, different operative procedures are used. The best results from operative treatment of membranous obstruction are obtained by excision of the membrane associated to pyloroplasty according to Heineke–Mikulicz or Finney.1–4 Transgastric excision of the pyloric membrane without pyloroplasty has also been reported.28 In case of longitudinal segmental atresia, the operative method depends on the length of the atresia. When the atresia is short, a Finney pyloroplasty can be carried out. For longer atresia, the procedure of choice is excision and end-to-end gastroduodenostomy.4 Gastrojejunostomy is not recommended, due to the high mortality rate4 and because of the risk of marginal ulcer and blind loop syndrome.
Complications of Gastric Surgery
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Excluding esophageal anastomoses after total gastrectomy, the overall incidence of anastomotic leak is <2% after gastric operations. Contained leaks may be controlled by percutaneous drainage, parenteral nutrition, nasogastric decompression, and broad-spectrum antibiotics. Unless there is distal obstruction or carcinoma of the suture line, the fistula tract should close. For patients with peritonitis and shock, or those in whom drainage is inadequate, an operation is needed. Small anastomotic defects may be closed primarily and covered with omentum. Commonly, revision of the anastomosis is required. The incidence of leak in a pyloroplasty after an ulcer operation is 5%.5 If there is minimal contamination, the anastomotic margins can be trimmed, and a new pyloroplasty can be performed. Large defects may require revision of the anastomosis. A Heineke–Mikulicz pyloroplasty may be converted to a Finney pyloroplasty, or, alternatively, a Billroth II anastomosis may be fashioned. For patients in unstable condition, the area should be widely drained, and a gastrostomy should be placed for gastric decompression. Similar treatment is used for a leaking gastroduodenostomy after a Billroth I anastomosis. Leaks along the reconstructed lesser curvature usually require additional resection and conversion to a Billroth II anastomosis. Perforation related to endoscopic mucosal resection and endoscopic submucosal dissection has the potential to expand the number of perforations associated with early gastric cancer as these procedures become more ubiquitous. Management is similar to other causes of perforation with the need for operation based on the presence of diffuse peritonitis or a progressive inflammatory response.8 Consideration also needs to be given to the status of the cancer resection when making operative plans.
Primary gastric lymphoma: A report of 16 pediatric cases treated at a single institute and review of the literature
Published in Pediatric Hematology and Oncology, 2020
Nilgün Kurucu, Canan Akyüz, Bilgehan Yalçın, İnci Y. Bajin, Ali Varan, Diclehan Orhan, İbrahim Karnak, Burça Aydın, Tezer Kutluk
In total, 11 patients underwent exploratory laparotomy. Six of them were found to be inoperable, and only biopsy was done. Gastrojejunostomy was performed without resection of the tumor in another patient. Furthermore, in Patient 5, solitary perforation over the gastric body was observed during surgery. The perforation was repaired, and gastrojejunostomy was performed. Subtotal gastrectomy with gastroduodenostomy or gastrojejunostomy was performed in three other patients. Five patients received radiotherapy to the tumor location. In Patient 7, radiotherapy was applied after two courses of chemotherapy because of progressive disease and obstructive jaundice. Chemotherapy could not be continued in Patient 11 because of severe hematological toxicity, and radiotherapy was applied. All patients except two were treated with various chemotherapeutic regimens including LSA2L2 and LMB protocols, depending on year of diagnosis and histopathological subtypes. Malignant lymphoid proliferation in the patient with MZL was resolved after H. pylori eradication.
Adult idiopathic hypertrophic pyloric stenosis - a common presentation with an uncommon diagnosis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Syed Moin Hassan, Ateeq Mubarik, Salman Muddassir, Furqan Haq
Multiple treatments have been proposed for AIHPS, including endoscopic dilation, pyloromyotomy with or without pyloroplasty, gastrectomy with a Billroth 1 gastroduodenostomy. Laparoscopic pyloroplasty is a less invasive option. Endoscopic dilation has a high rate of recurrence and provides only temporary relief of symptoms. It is an option in high-risk surgical patients. Currently, there is no evidence of one surgical technique being superior to another. Further research on AIHPS is warranted before a method can be finalized as the standard of care [10,13,21].
Linear Stapler versus Circular Stapler for Patients Undergoing Anastomosis for Laparoscopic Gastric Surgery: A Meta-Analysis
Published in Journal of Investigative Surgery, 2022
Tao Jin, Han-Dong Liu, Ze-Hua Chen, Jian-Kun Hu, Kun Yang
Furthermore, as shown in other studies, there was no statistically significant difference in anastomotic leakage between linear stapling and circular stapling [10–12]. The present study also showed that there was no obvious difference in the incidence of anastomotic leakage on the use of CSs and LSs despite the large sample size, either in patients with obesity or in those with gastric cancer receiving gastrojejunostomy, esophagojejunostomy, or gastroduodenostomy.
Related Knowledge Centers
- Pylorus
- Stomach Cancer
- Stomach
- Duodenum