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African Journal of Paediatric Surgery :... 2021Gastro-oesophageal reflux (GER) disease is one of the most common diseases amongst a wide range of chronic inflammatory diseases of the gastrointestinal tract in... (Review)
Review
Gastro-oesophageal reflux (GER) disease is one of the most common diseases amongst a wide range of chronic inflammatory diseases of the gastrointestinal tract in children of all ages, significantly impairing the quality of life of the child and posing a serious threat to the health of the patient. From 2008 to 2019, 134 patients aging from 6 months to 12 years were hospitalised at the Scientific Center for Pediatrics and Pediatric Surgery including 69 (51%) infants. Of them, 51 (38%) were the patients with persistent manifestations of regurgitation, despite an outpatient course of conservative therapy; 29 (22%) patients with recurrent reflux-associated pneumonia; also, 35 (26%) children with GER in the structure of the main pathology of the central nervous system, as well as 19 (14%) patients after surgery of the anastomosis of the oesophagus with its atresia. One hundred and seven (79.8%) patients underwent surgery. Nissen oesophagofundoplication was traditionally performed in 41 (38%) patients, in combination with Stamm gastrostomy in 14 (34%), with Mikulich pyloroplasty in 9 (22%) and in combination with gastrostomy and pyloroplasty in 12 (29%) children. Laparoscopic Nissen oesophagofundoplication was used in 16 (15%) cases. Thall oesophagofundoplication was performed in 48 (45%) patients, while in two (2%) cases, Boerema gastropexy was conducted. The immediate results were studied in all 107 patients. Complications in the form of gastric distress syndrome were revealed in four (3.7%) patients who did not undergo pyloroplasty, which in two (1.9%) cases required additional surgery of the stomach draining, whereas in the other two (1.9%) patients, the distress syndrome was stopped conservatively. A dumping syndrome was identified in two (1.9%) patients. Timely recognition of the pathological process, its nature and prevalence determines the indications for the use of various methods of operation, which are based on an individual approach to each patient.
Topics: Child; Gastroesophageal Reflux; Gastrostomy; Humans; Infant; Quality of Life; Stomach
PubMed: 34341194
DOI: 10.4103/ajps.AJPS_104_20 -
Asian Journal of Surgery Jan 2022In this study, we propose an improved Roux-en-Y (RY) surgical method by constructing a proximal jejunum pouch (PP-RY). Postoperative results were evaluated among...
BACKGROUND
In this study, we propose an improved Roux-en-Y (RY) surgical method by constructing a proximal jejunum pouch (PP-RY). Postoperative results were evaluated among patients with gastric cancer who underwent PP-RY and standard RY anastomosis.
METHODS
The clinical data of patients with gastric cancer who underwent laparoscopic total gastrectomy (LTG) in our center from May 2019 to May 2020 were collected retrospectively. We compared the short-term results of patients in the PP-RY and RY groups using 1:1 propensity score matching (PSM).
RESULTS
A total of 317 patients were selected, including those who received RY (n = 249) or PP-RY (n = 68) after LTG. After PSM, both groups had a sample size of 68. During the one-year follow-up period, the incidences of postoperative dumping syndrome (5.6%) and reflux esophagitis (14.8%) were significantly lower in the PP-RY group (P = 0.001 and P = 0.010, respectively). Weight loss (6.5 ± 2.0 kg) and albumin decrease (0.2 ± 0.1 g/dl) were significantly lower (P = 0.038 and P < 0.001, respectively), and the prognostic nutritional index (PNI) was significantly higher in the PP-RY group (P = 0.009). In the QLQ-C30 scale, the degree of anorexia in the PP-RY group was significantly lower than that in the RY group (P<0.05). In the QLQ-STO22 scale, chest and abdomen pain, dietary restriction, and anxiety were significantly lower in the PP-RY group (all P<0.05).
CONCLUSION
PP-RY can lead to obvious improvements in nutritional status, reduce short-term complications, and improve quality of life (QoL) for patients after LTG.
Topics: Abdominal Wall; Anastomosis, Roux-en-Y; Follow-Up Studies; Gastrectomy; Humans; Jejunum; Laparoscopy; Propensity Score; Quality of Life; Retrospective Studies; Stomach Neoplasms; Treatment Outcome
PubMed: 34315672
DOI: 10.1016/j.asjsur.2021.07.002 -
World Journal of Gastroenterology Jun 2021Although dumping symptoms constitute the most common post-gastrectomy syndromes impairing patient quality of life, the causes, including blood sugar fluctuations, are...
BACKGROUND
Although dumping symptoms constitute the most common post-gastrectomy syndromes impairing patient quality of life, the causes, including blood sugar fluctuations, are difficult to elucidate due to limitations in examining dumping symptoms as they occur.
AIM
To investigate relationships between glucose fluctuations and the occurrence of dumping symptoms in patients undergoing gastrectomy for gastric cancer.
METHODS
Patients receiving distal gastrectomy with Billroth-I (DG-BI) or Roux-en-Y reconstruction (DG-RY) and total gastrectomy with RY (TG-RY) for gastric cancer (March 2018-January 2020) were prospectively enrolled. Interstitial tissue glycemic profiles were measured every 15 min, up to 14 d, by continuous glucose monitoring. Dumping episodes were recorded on 5 patient-selected days by diary. Within 3 h postprandially, dumping-associated glycemic changes were defined as a dumping profile, those without symptoms as a control profile. These profiles were compared.
RESULTS
Thirty patients were enrolled (10 DG-BI, 10 DG-RY, 10 TG-RY). The 47 early dumping profiles of DG-BI showed immediately sharp rises after a meal, which 47 control profiles did not ( < 0.05). Curves of the 15 late dumping profiles of DG-BI were similar to those of early dumping profiles, with lower glycemic levels. DG-RY and TG-RY late dumping profiles (7 and 13, respectively) showed rapid glycemic decreases from a high glycemic state postprandially to hypoglycemia, with a steeper drop in TG-RY than in DG-RY.
CONCLUSION
Postprandial glycemic changes suggest dumping symptoms after standard gastrectomy for gastric cancer. Furthermore, glycemic profiles during dumping may differ depending on reconstruction methods after gastrectomy.
Topics: Anastomosis, Roux-en-Y; Blood Glucose; Blood Glucose Self-Monitoring; Gastrectomy; Humans; Prospective Studies; Quality of Life; Stomach Neoplasms; Treatment Outcome
PubMed: 34163119
DOI: 10.3748/wjg.v27.i23.3386 -
Surgery For Obesity and Related... Nov 2021Dumping syndrome (DS) and postbariatric hypoglycemia (PBH) are frequent complications of bariatric surgery. Previously known as "early and late dumping," these...
BACKGROUND
Dumping syndrome (DS) and postbariatric hypoglycemia (PBH) are frequent complications of bariatric surgery. Previously known as "early and late dumping," these complications have been separated due to differences in their onset and behaviors.
OBJECTIVES
To investigate a potentially common etiology of DS and PBH using an analysis of a mixed meal test (MMT) study.
SETTING
A large teaching hospital in the Netherlands.
METHODS
From all patients who underwent bariatric surgery in 2008-2011, a random selection completed an MMT (n = 47). Patients scored complaints related to DS and PBH with a standardized questionnaire at several time intervals. The groups were divided into patients with (DS+; n = 22) and without (DS-; n = 25) an increase in DS symptoms after the start of the MMT. Glucose and gut hormone levels were compared. Hypoglycemia was defined as a blood glucose level below 3.3 mmol/L.
RESULTS
The DS+ group had lower blood glucose values compared to the DS- group, which reached significance at 90 and 120 minutes (P < .05). For the DS+ group, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and satiety were higher at various time intervals (P < .05) compared to the DS- group. No differences were found for insulin and hunger score. GLP-1 and PYY were correlated with symptoms of DS.
CONCLUSION
Patients with DS complaints had lower postprandial glucose values. GLP-1 and PYY values were elevated in the DS+ group early and late during the test. These hormones also correlated with DS. These findings support the hypothesis of a common etiology of DS and PBH and a role of GLP-1 and PYY in both complications.
Topics: Bariatric Surgery; Blood Glucose; Dumping Syndrome; Gastric Bypass; Humans; Hypoglycemia; Obesity, Morbid; Peptide YY
PubMed: 34144916
DOI: 10.1016/j.soard.2021.05.020 -
World Journal of Gastrointestinal... May 2021The effects of various gastrectomy procedures on the patient's quality of life (QOL) are not well understood. Thus, this nationwide multi-institutional cross-sectional...
BACKGROUND
The effects of various gastrectomy procedures on the patient's quality of life (QOL) are not well understood. Thus, this nationwide multi-institutional cross-sectional study using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45), a well-established questionnaire designed to clarify the severity and characteristics of the postgastrectomy syndrome, was conducted.
AIM
To compare the effects of six main gastrectomy procedures on the postoperative QOL.
METHODS
Eligible questionnaires retrieved from 2368 patients who underwent either of six gastrectomy procedures [total gastrectomy with Roux-en-Y reconstruction (TGRY; = 393), proximal gastrectomy (PG; = 193), distal gastrectomy with Roux-en-Y reconstruction (DGRY; = 475), distal gastrectomy with Billroth-I reconstruction (DGBI; = 909), pylorus-preserving gastrectomy (PPG; = 313), and local resection of the stomach (LR; = 85)] were analyzed. Among the 19 main outcome measures of PGSAS-45, the severity and characteristics of postgastrectomy syndrome were compared for the aforementioned six gastrectomy procedures using analysis of means.
RESULTS
TGRY and PG significantly impaired the QOL of postoperative patients. Postoperative QOL was excellent in LR (cardia and pylorus were preserved with minimal resection). In procedures removing the distal stomach, diarrhea subscale (SS) and dumping SS were less frequent in PPG than in DGBI and DGRY. However, there was no difference in the postoperative QOL between DGBI and DGRY. The most noticeable adverse effects caused by gastrectomy were meal-related distress SS, dissatisfaction at the meal, and weight loss, with significant differences among the surgical procedures.
CONCLUSION
Postoperative QOL greatly differed among six gastrectomy procedures. The severity and characteristics of postgastrectomy syndrome should be considered to select gastrectomy procedures, overcome surgical shortcomings, and enhance postoperative care.
PubMed: 34122736
DOI: 10.4240/wjgs.v13.i5.461 -
Cureus May 2021Surgeries for obesity can lead to complications. Dumping syndrome is one such complication caused by the quick passage of hyperosmolar chyme from the stomach to the...
Surgeries for obesity can lead to complications. Dumping syndrome is one such complication caused by the quick passage of hyperosmolar chyme from the stomach to the duodenum. Mild cases can be cured with dietary modification and medical treatment. However, refractory cases may need invasive treatment options, such as transoral outlet reduction or surgery. We successfully treated a 48-year-old female with dumping syndrome, using a combination of argon plasma coagulation and hemoclips to narrow the pyloric lumen. We suggest that this new technique could be a cheap and easily accessible alternative to surgery, especially in countries where the specialised devices needed to treat such cases are unavailable.
PubMed: 34113505
DOI: 10.7759/cureus.14869 -
Journal of Metabolic and Bariatric... Jun 2021Dumping syndrome (DS) is an important but often underreported problem occurring after bariatric surgery. It is believed that gastric bypass procedures like Roux-en-Y...
PURPOSE
Dumping syndrome (DS) is an important but often underreported problem occurring after bariatric surgery. It is believed that gastric bypass procedures like Roux-en-Y Gastric By-pass (RYGB) and One-Anastomosis Gastric Bypass (OAGB) are more likely to cause DS than the pylorus-preserving Sleeve Gastrectomy (SG). The aim of this study was to evaluate the incidence of DS in patients undergoing SG, RYGB and OAGB.
MATERIALS AND METHODS
A retrospective clinical study with 180 patients undergoing SG (n=50), RYGB (n=53) and OAGB (n=77) between 2016-2018 was performed. All clinical and demo-graphic data were assessed. The percentage of excess weight loss (%EWL) was used to evaluate weight reduction. 127/180 (70.6%) patients took part in an additional phone interview. The incidence of DS was evaluated using validated Sigstad Score.
RESULTS
Information about the occurrence of dumping symptoms and patient satisfaction was obtained from 127 patients. Median follow-up was 20.0±11.4 months. Significant differences between the surgical procedures were found for the duration of surgery, complications, weight loss, incidence of DS and satisfaction postoperatively. DS occurred in 15.6% after SG, 56.4% after RYGB and 42.9% after OAGB. A higher weight loss was observed in patients who experienced dumping symptoms.
CONCLUSION
The present results show a clear superiority of SG regarding both perioperative results and incidence of DS compared to RYGB and OAGB and may impact clinicians and patients in their choice of procedure.
PubMed: 36687750
DOI: 10.17476/jmbs.2021.10.1.23 -
Langenbeck's Archives of Surgery Nov 2021Surgery is the cornerstone of esophageal cancer treatment but remains burdened with significant postoperative changes of gastrointestinal function and quality of life. (Review)
Review
BACKGROUND
Surgery is the cornerstone of esophageal cancer treatment but remains burdened with significant postoperative changes of gastrointestinal function and quality of life.
PURPOSE
The aim of this narrative review is to assess and summarize the current knowledge on postoperative functional syndromes and quality of life after esophagectomy for cancer, and to provide orientation for the reader in the challenging field of functional aftercare.
CONCLUSIONS
Post-esophagectomy syndromes include various conditions such as dysphagia, reflux, delayed gastric emptying, dumping syndrome, weight loss, and chronic diarrhea. Clinical pictures and individual expressions are highly variable and may be extremely distressing for those affected. Therefore, in addition to a mostly well-coordinated oncological follow-up, we strongly emphasize the need for regular monitoring of physical well-being and gastrointestinal function. The prerequisite for an effective functional aftercare covering the whole spectrum of postoperative syndromes is a comprehensive knowledge of the pathophysiological background. As functional conditions often require a complex diagnostic workup and long-term therapy, close interdisciplinary cooperation with radiologists, gastroenterologists, oncologists, and specialized nutritional counseling is imperative for successful management.
Topics: Aftercare; Dumping Syndrome; Esophageal Neoplasms; Esophagectomy; Humans; Postoperative Complications; Quality of Life
PubMed: 34036407
DOI: 10.1007/s00423-021-02203-y -
Medicine May 2021Dumping syndrome is a frequent and potentially severe complication after gastric surgery. Beinaglutide, a recombinant human glucagon-like peptide-1 (GLP-1) which shares...
RATIONALE
Dumping syndrome is a frequent and potentially severe complication after gastric surgery. Beinaglutide, a recombinant human glucagon-like peptide-1 (GLP-1) which shares 100% homology with human GLP-1(7-36), has never been reported in the treatment of dumping syndrome before.
PATIENT CONCERNS
The patient had undergone distal gastrectomy for gastric signet ring cell carcinoma 16 months ago. He presented with symptoms of paroxysmal palpitation, sweating, and dizziness for 4 months.
DIAGNOSIS
He was diagnosed with late dumping syndrome.
INTERVENTIONS AND OUTCOMES
The patient was treated with dietary changes and acarbose for 4 months before admitted to our hospital. The treatment with dietary changes and acarbose did not prevent postprandial hyperinsulinemia and hypoglycemia according to the 75 g oral glucose tolerance test (OGTT) and continuous glucose monitoring (CGM) on admission.Therefore, the patient was treated with beinaglutide 0.1 mg before breakfast and lunch instead of acarbose. After the treatment of beinaglutide for 1 month, OGTT showed a reduction in postprandial hyperinsulinemia compared with before starting treatment, and the time in the range of 3.9 to 10 mmol/L became 100% in CGM. No side effect was observed in this patient during beinaglutide treatment.
LESSONS
These findings suggest that beinaglutide may be effective for treating post-gastrectomy late dumping syndrome.
Topics: Blood Glucose; Carcinoma, Signet Ring Cell; Dumping Syndrome; Gastrectomy; Glucagon-Like Peptide 1; Glucose Tolerance Test; Humans; Hyperinsulinism; Hypoglycemia; Male; Middle Aged; Peptide Fragments; Postprandial Period; Recombinant Proteins; Stomach Neoplasms; Treatment Outcome
PubMed: 34032745
DOI: 10.1097/MD.0000000000026086 -
Endocrinology, Diabetes & Metabolism... Mar 2021Hypoglycemia is an uncommon clinical problem in non-diabetic patients or patients not being treated for diabetes mellitus. It is a rare, but well-established...
SUMMARY
Hypoglycemia is an uncommon clinical problem in non-diabetic patients or patients not being treated for diabetes mellitus. It is a rare, but well-established complication of bariatric surgery and, in some cases, it can be the only symptom of another medical problem. A 50-year-old woman with a history of partially recovered hypopituitarism after transsphenoidal surgery for a non-functioning pituitary macroadenoma complained about symptomatic hypoglycemia after sleeve gastrectomy surgery. Our initial studies failed to determine the cause for these episodes and treatment with acarbose (suspecting a dumping syndrome) was not helpful. Finally, laboratory findings revealed growth hormone (GH) deficiency. The patient received treatment with GH, with the resolution of symptoms after 3 months of treatment. Our case suggests that all causes of hypoglycemia should be considered and studied after bariatric surgery. An improvement in insulin-resistance following bariatric surgery can trigger clinical manifestations of GH deficiency.
LEARNING POINTS
Postprandial hypoglycemia after bariatric surgery is usually due to dumping syndrome. Even after bariatric surgery, all causes of hypoglycemia should be considered and studied. After significant weight loss, insulin sensitivity is usually restored and can trigger clinical manifestations of GH deficiency. Hypoglycemia is a rare symptom of GH deficiency.
PubMed: 33845452
DOI: 10.1530/EDM-20-0131