Motor function was investigated by constant perfusion manometry in the Roux limb of ten patients who had undergone total gastrectomy and Roux-en-Y anastomosis. Results showed that in the fasting state, the migrating motor complex (MMC) was comletely absent, retrograde in direction or bursts of nonphasic pressure activity. Reduced motor activity patterns occurred after the meal in some patients. Four patients failed to convert fasting state into the feeding state. Total gastrectomy with Roux-en-Y anastomoses provakes a relatively severe distubance in motor function, which could contribute to postoperative upper abdominal distress.
Objective To investigate the influence on the postoperative recovery for giving either total parenteral nutrition （TPN） or early enteral nutrition (EEN) to patients with gastric cancer after total gastrectomy. Methods Eighty-six patients with gastric cancer undergone total gastrectomy were divided into TPN group (n=31) and EEN group (n=55). Patients in TPN group received TPN support via vena cava (internal jugular vein or subclavian vein), while patients in EEN group received early feeding through the naso-intestinal tube, which was placed during operation, and volume of enteral nutrition (fresubin) was increased daily, full enteral nutrition was expected on day 3-5. Nutrition status after operation, postoperative plasma albumin (Alb), the time of passing gas or stool, the time of oral intake, hospital stay and any postoperative complications were recorded and analyzed. Results There were no significant differences between two groups (Pgt;0.05) in postoperative plasma Alb level, the time of passing gas or stool, postoperative complications rate or hospital stay. However, in the TPN group, the time of oral intake was shorter than that in EEN group (P=0.004). Conclusions Both TPN and EEN are the suitable nutritional methods for patients with gastric cancer after total gastrectomy, and with no detectable difference. For patients with high risk, such as severe malnutrition, naso-intestinal tube should be placed for EEN.
ObjectiveTo prospectively study the effect of preventing postoperative reflux esophagitis with esophagogastrostomy and RouxenY gastrojejunostomy after proximal subtotal gastrectomy.MethodsTwentysix cases of carcinoma of the gastric fundus and cardia were allocated randomly to 2 groups (the control group with 12 cases and the experimental group with 14 cases) according to odd or even number of the admission number.After proximal subtotal gastrectomy and esophagogastrostomy, the control group underwent pyloroplasty while the experimental group with pyloruspreserving RouxenY gastrojejunostomy.The inflammatory reaction of the tissue obtained at the esophagogastric junction using a fiber gastroscope was observed after half year of postoperative followup in the two groups.An examination of gastric emptying of a radionuclidelabeled test meal were performed.According to the Visick score of followup data,the effects of operation were evaluated.The 5year survival rate was also evaluated.ResultsThe postoperative gastrointestinal symptoms in the experimental group were slighter than those in the control group.The examination of gastric emptying of a radionuclidelabeled test meal showed that the gastric emptying time of a half dose,gastric remains rates of radionuclide after 10 min and 60 min in the experimental group were similar to those in the control healthy people group.But in the control group,the gastric emptying time of a half dose delayed,and the gastric remains rate of radionuclide after 10 min and 60 min were higher than the other groups.The biopsy study of the esophagogastric junction showed that the inflammatory reaction in the experimental group was slighter than that in the control group.There was no significant difference between the two groups in the survival rate.ConclusionFor patients with carcinoma of the gastric fundus and cardia, after proximal subtotal gastrectomy and esophagogastrostomy,compared with pyloroplasty,pyloruspreserving RouxenY gastrojejunostomy can decrease the reflux esophagitis,and relieve the postoperative gastrointestinal symptoms.
With the swift evolution of bariatric and metabolic surgery, additional procedures building upon sleeve gastrectomy have consistently surfaced. Recent studies suggest that sleeve gastrectomy with jejunojejunal bypass (SG-JJB) yields superior short-term weight reduction outcomes compared to sleeve gastrectomy alone, with weight loss and glycemic control effects akin to Roux-en-Y gastric bypass, and without significant complications. As a result, SG-JJB is regarded as a safe and efficacious bariatric procedure, noted for its technical simplicity and reversibility, presenting substantial clinical utility. Nonetheless, high-quality, multicenter, large-sample, long-term follow-up randomized controlled trials are essential to further ascertain its long-term efficacy and safety, and to facilitate its standardized implementation. This article seeks to review the advancements in SG-JJB research, evaluate its effectiveness and safety in managing obesity and associated comorbidities, and explore its future developmental trajectory.
ObjectiveTo compare the results of laparoscopic-endoscopic cooperative resection and open surgery for gasric stromal tumor.
MethodsFrom January 2010 to March 2015, the clinical data of 56 cases undergoing laparoscopic resection for gasric stromal tumor and 53 cases of traditional operation selected during the same period were retrospectively compared.
ResultsThere was no significant difference between two groups in patient's gender, age, body weight, size of tumor, tumor staging, method of operation, intraoperative conditions, postoperative overall complications, local recurrence, and distant metastasis. There were 1 case with the rupture of tumor and 1 case of open surgery transforming in laparoscopic group. In another group, there was the absence of the rupture of tumors. There was no mortality, stomach bleeding, stenosis or leakage occurred between two groups. In laparoscopic group, there were less operative blood loss and abdominal drainage, shorter time of postoperative anal exhaust time, fewer anodyne, a reduction of hospital stay than in convention operation group.However, laparoscopic resection required greater hospital costs and longer operative time. There were significant differences between two groups (P < 0.05). Conciusions With advantages of less blood loss and quicker recovery as compared to conventional operation. Laparoscopic-endoscopic cooperative resection for gasric stromal tumor has similar effect when it is performed by well selection of cases, skilled surgeon with experience on open resection for surgical treatment of gastric stromal tumor.
ObjectiveTo compare the postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG) and single-anastomosis sleeve ileal bypass (SASI), and to explore the risk factors for PONV. MethodA total of 220 patients at the Affiliated Hospital of Xuzhou Medical University from June 2022 to December 2022 were prospectively collected, and were randomly divided into the LSG group and the SASI group; the general condition of the patients was recorded. PONV was assessed on the POD0, POD1, POD2, POD30, POD60, POD90, using the Rhodes index score.ResultsThe total Rhodes index score in the LSG group was higher than that in the SASI group [(25.56±13.54) vs. (16.06±11.28), P＜0.05]. The results of multiple linear regression analysis showed that female (P=0.014), LSG (P＜0.001), young age (P=0.050), and low BMI (P=0.019) were risk factors for PONV. ConclusionsCompared with LSG, the Rhodes index score after SASI is low. For young women with low BMI, special attention should be paid to the prevention and treatment of PONV after LSG.
