The Twentieth Century
Arturo Castiglioni in A History of Medicine, 2019
The concept of peptic ulcer has undergone considerable modification as to incidence, pathogenesis, and therapy. The present century is marked by the recognition of the greater frequency of duodenal ulcer, as popularized by the surgeon Berkeley, Lord moynihan (1910), far outranking gastric ulcer in numerical importance. The psychological concepts of Sir Arthur Frederick hurst (1879–1944) contributed much to the understanding of the course and nature of peptic ulcer. B. W. sippy’s treatment of ulcer (1915) has become widely established; Einar meulengracht, of Copenhagen, introduced the clinical concept of liberal feeding of bleeding ulcers. The surgical treatment of peptic ulcer has also made noteworthy advances. Gastroenterostomy as a curative operation is discredited; subtotal gastrectomy, devised by H. von haberer (b. 1875) and popularized by H. finsterer (b. 1877) and Jeno polya (b. 1876), and in America by A. A. berg (b. 1872), marks a new era in the surgery of peptic ulcer. The relative merit of medical and surgical treatment is no longer a controversial subject, though many other aspects of the problem of peptic ulcer are still unsolved.
Alcohol and Sedatives
Frank Lynn Iber in Alcohol and Drug Abuse as Encountered in Office Practice, 2020
Alcohol is absorbed slowly from the stomach, but extremely rapidly from the small intestine. Ingestion with food, particularly fatty or hypertonic foods, retards gastric emptying and slows absorption. After gastric surgery with gastroenterostomy, absorption is fast, comparable to direct duodenal instillation. Some 50% of a dose of intraduodenally administered alcohol is absorbed in 3 min. In contrast, 50% of an oral dose taken with a meal requires 30 to 60 min for absorption. There is a large first-pass effect of alcohol that is approximately 25% of the initial drink, but less as the liver enzymes become saturated. Alcohol is rapidly distributed in the total body water and also dissolves in bilipid membranes such that its volume of distribution is slightly greater than the body water content. Absorption is always complete.
The pancreas, the neuroendocrine system, neoplasia, traditional open pancreatectomy
Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner in Endocrine Surgery, 2017
An end-to-side gastroenterostomy can be either a Polya or Hofmeister type, with either hand-sewn or stapling techniques. The gastroenterostomy should be placed in the antecolic position.Pylorus-sparing pancreaticoduodenectomyThe pylorus-saving modified Whipple procedure provides sparing of the entire stomach, but the slow gastric emptying in the early postoperative phase can be a problem.A segment of proximal duodenum, not less than 2 cm from the pylorus, and preservation of right gastroepiploic and right gastric arteries must exist to provide functional integrity.A single layer of interrupted nonabsorbable or PDS sutures are better to avoid a short and/or narrow duodenum.The prolonged gastroparesis in the early postoperative phase, and the small risk of instrumental arterial thrombosis of the right gastric or right gastroepiploic arteries, did not diminish the acceptance by the surgical community.The concerns about incomplete lymphadenectomy or clear tissue margins, especially around the preserved proximal duodenum, have not influenced the long-term results of survival.
Combined endovascular and surgical treatment of a giant celiac artery aneurysm with consequent gastric outlet obstruction: a case report and literature review
Published in Acta Chirurgica Belgica, 2023
Nick Smet, Thijs Buimer, Tim Van Meel
After the patient’s intake returned to normal, the feeding tube was removed. Regression of biochemical cholestasis was seen. The patient made an uneventful recovery and was discharged after one week. After three months, he returned to the outpatient clinic with recurrent gastric outlet obstruction, and blood test showed no cholestasis. Control CT demonstrated no regression of the aneurysm and compression of the duodenum. It was decided to perform a gastroenterostomy in order to deviate the compressed duodenum. Due to persistent gastroparesis and thus ineffectiveness of the gastroenterostomy alone, a complemental Roux-en-Y anastomosis was made. The further postoperative course was uneventful. The last visit in the outpatient clinic was in October 2021, the patient had no residual digestive complaints and has gained weight. A CT abdomen was conducted which showed decrease of the aneurysm from 14 to 6 cm.
Retrieval anchor-assisted endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction
Published in Scandinavian Journal of Gastroenterology, 2020
Jinlong Hu, Guoxin Wang, Kai Zhang, Nan Ge, Sheng Wang, Jintao Guo, Xiang Liu, Siyu Sun
Endoscopic gastroenterostomy is an emerging approach in the management of GOO, including NOTES gastroenterostomy and EUS-GE. Compared with laparoscopic gastroenterostomy and endoscopic stent, endoscopic gastroenterostomy is a minimally invasive method associated with high rates of long-term effectiveness. EUS-GE might be the most optimal method, as it involves fewer changes of endoscopic instruments while helping achieve the desired anastomotic distance [18]. However, EUS-GE remains technically challenging, as the small intestine has a narrow lumen and is not dilated under normal conditions [19]. There are several key aspects to performing this procedure. The present study incorporated some of the recently proposed improvements to the procedure associated with increases success rate of EUS-GE.
Marginal ulcers and associated risk factors after Roux-en-Y gastric bypass
Published in Baylor University Medical Center Proceedings, 2023
Matthew Wynn, Kristen M. Tecson, David Provost
Of the 43 patients, 24 (56%) presented on an elective basis, all of whom were treated with resection of the gastroenterostomy and reanastomosis (Table 1). These patients underwent this surgery a median of 90 [33, 136] days following initial consultation for the ulcer. The remaining 19 patients (44%) presented with perforation in an urgent setting, all of whom were treated with omental patch repair of the perforated ulcer. Only 2 (11%) of these 19 patients subsequently underwent elective resection of the gastroenterostomy and reanastomosis. Forty (93%) of the 43 patients were managed laparoscopically. An open approach was used for the other 3 (7%) patients, all of whom presented with perforation. The location of the ulcers varied among patients. A total of 24 (56%) were located at the gastrojejunal anastomosis, 14 (33%) were on the jejunal side, and only 1 (2%) on the gastric side. There were 12 (28%) located anteriorly, and only 1 (2%) posteriorly. Additionally, there was 1 (2%) duodenal ulcer and 1 (2%) pyloric ulcer on the gastric remnant. In the other 2 patients, the location of the ulcer was not reported. Other intraoperative findings included stricture (14, 33%), gastrogastric fistula (7, 16%), and bleeding (8, 19%). The median time to ulcer was 6 [2, 10] years, with 15 (35%) patients requiring surgery within 5 years of their index procedure. Table 2 lists findings related to the clinical course. The median length of stay for all patients was 3 [2, 5] days. Postoperatively, 7 patients (16%) required admission to the ICU. There were no deaths within 30 days of surgery; however, one patient expired at a skilled nursing facility after discharge more than 30 days from surgery, and one patient expired over a year later due to complications from alcoholic cirrhosis.
Related Knowledge Centers
- Antibiotic
- Gastrectomy
- Small Intestine
- Jejunum
- Stomach
- Gastroparesis
- Duodenum
- Helicobacter Pylori
- Peptic Ulcer Disease
- Gastroesophageal Reflux Disease