-
Medicine Feb 2024This study retrospectively analyzed the clinical efficacy of Uncut Roux-en-Y and Billroth II anastomoses in gastrointestinal reconstruction following laparoscopic D2...
Comparative efficacy of uncut Roux-en-Y and Billroth II anastomosis in gastrointestinal reconstruction following laparoscopic radical gastrectomy for distal gastric cancer.
This study retrospectively analyzed the clinical efficacy of Uncut Roux-en-Y and Billroth II anastomoses in gastrointestinal reconstruction following laparoscopic D2 radical gastrectomy for distal gastric cancer. The primary objective was to compare the postoperative outcomes, including quality of life and complication rates, between the 2 surgical techniques. One hundred patients diagnosed with distal gastric cancer were enrolled between June 2020 and May 2023. Patients underwent laparoscopic D2 gastrectomy and were categorized into either the Uncut Roux-en-Y or Billroth II anastomosis groups based on the technique used for gastrointestinal reconstruction. The inclusion and exclusion criteria were strictly followed. Surgical parameters, quality of life assessed using the Visick grading index, and postoperative complications were also evaluated. Statistical analyses were performed using SPSS version 27.0. The groups were comparable in terms of demographic and baseline clinical parameters. The Uncut Roux-en-Y group had a significantly longer duration of surgery (P < .001). However, there were no statistically significant differences in other surgical parameters. According to the Visick grading index, patients in the Uncut Roux-en-Y group reported a significantly better quality of life than those in the Billroth II group (P < .05). Additionally, Uncut Roux-en-Y was associated with a significantly lower incidence of dumping syndrome and bile reflux (P < .05). Although Uncut Roux-en-Y anastomosis requires longer surgical time, it offers significant advantages in terms of postoperative quality of life and reduced rates of dumping syndrome and bile reflux. Our findings suggest that Uncut Roux-en-Y may be a superior option for gastrointestinal reconstruction after laparoscopic D2 gastrectomy for distal gastric cancer.
Topics: Humans; Stomach Neoplasms; Anastomosis, Roux-en-Y; Dumping Syndrome; Bile Reflux; Quality of Life; Retrospective Studies; Gastroenterostomy; Gastrectomy; Treatment Outcome; Postoperative Complications; Laparoscopy
PubMed: 38306517
DOI: 10.1097/MD.0000000000037037 -
Cureus Dec 2023The laparoscopic sleeve gastrectomy is the most common bariatric surgery performed to promote weight loss and improve obesity-related comorbidities. As the number of...
The laparoscopic sleeve gastrectomy is the most common bariatric surgery performed to promote weight loss and improve obesity-related comorbidities. As the number of patients undergoing sleeve gastrectomy increases, so does the prevalence of complications. It is crucial to recognize both common and unusual complications of sleeve gastrectomy to properly diagnose and manage them. We present a unique case of gastric outlet obstruction not visualized on initial imaging and acute pancreatitis following a sleeve gastrectomy. We recommend performing an endoscopy and ordering serum lipase levels in a patient with negative CT scans but persistent postoperative nausea, vomiting, and abdominal pain. The management of postoperative gastric outlet obstruction includes supportive care, balloon dilation of the stenotic area, or gastric bypass if symptoms persist.
PubMed: 38274899
DOI: 10.7759/cureus.51118 -
In Vivo (Athens, Greece) 2024Based on gastric shape, patients with gastric cancer can be divided into storage (hook-shaped and ptotic stomach) and reverse outflow (steer-horn and cascade stomach)...
BACKGROUND/AIM
Based on gastric shape, patients with gastric cancer can be divided into storage (hook-shaped and ptotic stomach) and reverse outflow (steer-horn and cascade stomach) groups. In patients with gastric cancer, postoperative loss of lean body mass (LBM) is associated with a poor prognosis. This study investigated the influence of preoperative gastric shape on LBM loss 1 month after curative distal gastrectomy.
PATIENTS AND METHODS
Between May 2011 and May 2019, we enrolled 487 patients with pathological stage IA/IB/IIA gastric cancer who underwent curative distal gastrectomy and did not receive adjuvant chemotherapy. Patients were divided into storage (n=370) and outflow (n=117) groups according to whether barium was stored in the stomach during the preoperative fluoroscopic examination. Clinicopathological features, LBM 1 month after gastrectomy, and predictors of postoperative LBM loss were compared between the groups using multivariable logistic regression.
RESULTS
The incidence of >5% LBM loss and >7.5% body weight loss 1 month postoperatively were significantly higher in the storage group than in the outflow group (p=0.003 and p=0.009, respectively). Multivariable analysis revealed that gastric shape [odds ratio (OR)=3.30, 95% confidence interval (CI)=1.95-5.59, p<0.001], male sex (OR=3.20, 95% CI=2.07-4.96, p<0.001), and Roux-en-Y reconstruction (OR=1.69, 95% CI=1.08-2.64, p=0.02) were independent predictors of LBM loss. Postoperative dietary problems, especially dumping syndrome, diarrhea, and reflux were more common in the storage group (p<0.001).
CONCLUSION
Gastric shape may be a useful independent predictor of postoperative LBM loss in patients with gastric cancer undergoing distal gastrectomy.
Topics: Humans; Male; Stomach Neoplasms; Gastroenterostomy; Gastrectomy; Body Composition; Postoperative Complications; Treatment Outcome; Retrospective Studies
PubMed: 38148040
DOI: 10.21873/invivo.13458 -
Journal of Clinical Medicine Dec 2023Esophagectomy is a technically complex operation performed for both benign and malignant esophageal disease. Medical and surgical advancements have led to improved... (Review)
Review
Esophagectomy is a technically complex operation performed for both benign and malignant esophageal disease. Medical and surgical advancements have led to improved outcomes in esophagectomy patients over the past several decades; however, surgeons must remain vigilant as complications happen often and can be severe. Post-esophagectomy complications can be grouped into early and late categories. The aim of this review is to discuss the early complications of esophagectomy along with their risk factors, work-up, and management strategies with special attention given to anastomotic leaks.
PubMed: 38137691
DOI: 10.3390/jcm12247622 -
Cureus Nov 2023Data on the effect of dietary fat on dumping syndrome (DS) symptoms are limited. The aim of this study was to assess the effect of the addition of fat to a carbohydrate...
BACKGROUND/OBJECTIVES
Data on the effect of dietary fat on dumping syndrome (DS) symptoms are limited. The aim of this study was to assess the effect of the addition of fat to a carbohydrate meal on the appearance of DS symptoms and glycemic response, in patients who had undergone gastric surgery.
SUBJECTS/METHODS
This was an interventional crossover study. Patients scheduled for gastric surgical procedures related to DS at two surgical units of two public hospitals (General University Hospital of Larissa and General Hospital of Larissa) were considered for study inclusion. Patients presenting symptoms suggestive of diagnosis (n = 12), after the ingestion of a carbohydrate meal, were used as both intervention and control groups. During the intervention process, a fat supplement was added to the carbohydrate meal that was previously used for diagnosis. Glycemic response and the amount and intensity of DS symptoms provoked by the two meals were assessed at both appointments.
RESULTS
Blood glucose levels were significantly lower in the group that consumed the added fat meal compared with the group that consumed the carbohydrate meal 60 minutes after ingestion (p = 0.028). Furthermore, a significant reduction was noted in the amount of late dumping symptoms (p = 0.021) and the intensity of both early and late dumping symptoms (p = 0.007 and p = 0.012 respectively), after fat addition. Conclusions: Incorporating fat into a carbohydrate meal seems to attenuate postprandial blood glucose rises and reduce the amount and intensity of DS symptoms, in patients who had undergone gastric surgery.
PubMed: 38106774
DOI: 10.7759/cureus.48871 -
Cureus Nov 2023Obesity is a global public health crisis associated with numerous medical conditions and increased mortality rates. Weight loss surgery, or bariatric surgery, has become... (Review)
Review
Obesity is a global public health crisis associated with numerous medical conditions and increased mortality rates. Weight loss surgery, or bariatric surgery, has become a crucial treatment option for clinically severe obesity. Bariatric surgery is an effective treatment for severe obesity but it carries the potential for various complications, both in the short and long term. This article provides a comprehensive overview of these complications, aiding healthcare professionals in their management and patients in understanding the risks associated with bariatric surgery. The review explores the short-term complications of bariatric surgery, emphasizing anastomotic leaks, strictures, hemorrhages, infections, marginal ulcers, gastroesophageal reflux disease (GERD), and dumping syndrome. It provides insights into the diagnosis and management of these complications, emphasizing the importance of early recognition and intervention. Furthermore, the article delves into the late complications of adjustable gastric banding (LAGB), vertical sleeve gastrectomy (VSG), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion with duodenal switch (BPDDS). It discusses complications such as band slippage and erosion in LAGB, nutritional deficiencies in VSG and RYGB, and unique complications related to BPDDS.
PubMed: 38084166
DOI: 10.7759/cureus.48580 -
Cureus Nov 2023Bariatric surgery (BS) has emerged as an efficient approach for addressing obesity, offering long-term benefits encompassing substantial weight loss and improving... (Review)
Review
Bariatric surgery (BS) has emerged as an efficient approach for addressing obesity, offering long-term benefits encompassing substantial weight loss and improving metabolic disorders. Many women of childbearing age opt for BS to enhance their health and well-being. The weight loss achieved through these procedures can positively impact pregnancy outcomes, but it's crucial to consider potential drawbacks. Micronutrient deficiencies, such as anemia resulting from iron or vitamin B12 deficiency, are a legitimate concern. Making the decision to have a BS is a complex process with many possible obstacles. The complicated nature of this decision is highlighted by worries about dumping syndrome, surgical complications that could include the risk of internal hernias, and the possibility that infants could be labeled as small for gestational age because of maternal undernourishment. Furthermore, there is a notable absence of international consensus regarding the ideal timing for conceiving after undergoing BS. Therefore, this narrative review extensively explores the existing body of literature, offering insights into the prevailing challenges encountered before and during pregnancy following BS. These challenges encompass a wide range of considerations, commencing with fertility-related issues. The study will cover strategies for addressing vitamin and nutritional deficiencies through supplementation, subtleties of post-BS altered glucose metabolism and how it affects the detection and treatment of gestational diabetes, how dumping syndrome progresses, various surgical problems, and how different bariatric procedures affect pregnancy and fetal outcomes. These include a tendency to give birth to children considered undersized for gestational age, nutritional deficits, anemia, and abnormal maternal glucose metabolism. This review offers a comprehensive exploration of the multifaceted landscape of pregnancy in the context of BS. It aims to provide a valuable resource for healthcare professionals and women considering pregnancy after undergoing BS, enabling them to make well-informed decisions and receive appropriate care during this critical phase of life.
PubMed: 38074055
DOI: 10.7759/cureus.48513 -
Cancers Nov 2023Transthoracic esophagectomy results in a radical change in foregut anatomy with multiple consequences for digestive physiology. The aim of this study was to identify...
Transthoracic esophagectomy results in a radical change in foregut anatomy with multiple consequences for digestive physiology. The aim of this study was to identify factors associated with poor functional outcomes by assessing multiple dimensions of digestive performance and health-related quality of life (HRQL). Patients with cancer-free survival after Ivor Lewis esophagectomy were included. Four functional syndromes (dysphagia, gastroesophageal reflux disease (GERD), delayed gastric conduit emptying (DGCE), and dumping syndrome (DS)) and HRQL were assessed using specifically designed questionnaires. Patient outcomes were compared with healthy controls. Independent factors associated with poor digestive performance were identified through multivariable analysis. Sixty-five postoperative patients and 50 healthy volunteers participated in this study. Compared with controls, patients had worse outcomes for dysphagia, GERD, DS, and HRQL, but not for DGCE. A multivariate analysis showed a significant correlation of reduced digestive performance with ASA score, squamous cell carcinoma, open or hybrid surgical approach, and (neo)adjuvant therapy. In contrast, no individual patient factor was found to be associated with dumping syndrome. Digestive function and HRQL are substantially impaired after Ivor Lewis esophagectomy for cancer. Comorbid patients undergoing multimodal treatment and open access surgery for squamous cell carcinoma have the highest risk of poor functional outcome.
PubMed: 38067274
DOI: 10.3390/cancers15235569 -
Obesity Surgery Jan 2024We reviewed the literature on the prevalence of small intestinal bacterial overgrowth (SIBO) after Roux-en-Y gastric bypass (RYGB). Eight studies examining 893 patients... (Meta-Analysis)
Meta-Analysis Review
We reviewed the literature on the prevalence of small intestinal bacterial overgrowth (SIBO) after Roux-en-Y gastric bypass (RYGB). Eight studies examining 893 patients were included. The mean age of the patients was 48.11 ± 4.89 years. The mean BMI before surgery and at the time of SIBO diagnosis was 44.57 ± 2.89 kg/m and 31.53 ± 2.29 kg/m, respectively. Moreover, the results showed a 29% and 53% prevalence of SIBO at < 3-year and > 3-year follow-up after RYGB, respectively. Symptoms included abdominal pain, diarrhea, bloating, nausea, vomiting, constipation, soft stool, frequent defecation, flatulence, rumpling, dumping syndrome, and irritable bowel syndrome. SIBO is prevalent after RYGB; digestive symptoms should prompt the consideration of SIBO as a potential etiology. Antibiotic therapy has proven to be therapeutic.
Topics: Humans; Adult; Middle Aged; Gastric Bypass; Obesity, Morbid; Prevalence; Biliopancreatic Diversion; Flatulence; Gastrectomy; Retrospective Studies
PubMed: 38062344
DOI: 10.1007/s11695-023-06974-9 -
Pediatric Surgery International Nov 2023Patients affected by microgastria, severe gastroesophageal reflux, or those who have undergone subtotal gastrectomy, have commonly described reporting dumping syndromes...
PURPOSE
Patients affected by microgastria, severe gastroesophageal reflux, or those who have undergone subtotal gastrectomy, have commonly described reporting dumping syndromes or other symptoms that seriously impair the quality of their life. Gastric tissue engineering may offer an alternative approach to treating these pathologies. Decellularization protocols have great potential to generate novel biomaterials for large gastric defect repair. There is an urgency to define more reliable protocols to foster clinical applications of tissue-engineered decellularized gastric grafts.
METHODS
In this work, we investigated the biochemical and mechanical properties of decellularized porcine stomach tissue compared to its native counterpart. Histological and immunofluorescence analyses were performed to screen the quality of decellularized samples. Quantitative analysis was also performed to assess extracellular matrix composition. At last, we investigated the mechanical properties and cytocompatibility of the decellularized tissue compared to the native.
RESULTS
The optimized decellularization protocol produced efficient cell removal, highlighted in the absence of native cellular nuclei. Decellularized scaffolds preserved collagen and elastin contents, with partial loss of sulfated glycosaminoglycans. Decellularized gastric tissue revealed increased elastic modulus and strain at break during mechanical tensile tests, while ultimate tensile strength was significantly reduced. HepG2 cells were seeded on the ECM, revealing matrix cytocompatibility and the ability to support cell proliferation.
CONCLUSION
Our work reports the successful generation of acellular porcine gastric tissue able to support cell viability and proliferation of human cells.
Topics: Humans; Animals; Swine; Gastrectomy; Dumping Syndrome; Biocompatible Materials; Cell Proliferation
PubMed: 38032517
DOI: 10.1007/s00383-023-05591-y