Gastric Resection Surgery Research Articles

Evaluation of the function of external respiration in patients with morbid obesity after gastric longitudinal resection surgery

Evaluation of the function of external respiration in patients with morbid obesity after gastric longitudinal resection surgery

The clinical impact of malnutrition on the postoperative outcomes of patients undergoing gastrectomy for gastric cancer: Propensity score matched analysis of 2011-2017 hospital database.

Malnutrition is a prominent feature of gastric cancer patients who suffer from gastric outlet obstruction, impaired peristalsis, and cancer-mediated disruptions in metabolic hemostasis. In this study, we systematically evaluate the impact of malnutrition on the postoperative outcome of patients with gastric cancer undergoing gastrectomy. 2011-2017 National Inpatient Sample was used to isolate patients with gastric cancer who underwent gastrectomy, who were stratified using malnutrition. The malnutrition-present cohort was matched to the malnutrition-absent controls using 1:1 propensity score-matching analysis, and compared to the following endpoints: mortality, length of stay (LOS), hospitalization costs, and postoperative complications. 5309 were identified to have undergone gastric resection procedure for gastric cancer, from which there were 1044 with malnutrition and 1044 matched controls. Malnourished patients had higher mortality (6.80 vs 3.83% p=0.003, OR 1.83 95% CI 1.23-2.73), LOS (17.2 vs 11.4d p<0.001), costs ($197,702 vs $124,133 p<0.001), and were more often discharged to rehabilitation facilities. Malnourished patients had higher rates of wound complications (3.64 vs 1.25% p<0.001, OR 3.00 95% CI 1.59-5.66), infection (6.90 vs 3.26% p<0.001, OR 2.20 95% CI 1.45-3.34), and respiratory failure (6.80 vs 3.64% p=0.002, OR 1.93 95% CI 1.29-2.89). In multivariate analysis, malnourished patients had higher rates of mortality (p=0.002, aOR 1.87 95% CI 1.25-2.80), length of stay (p<0.001, aOR 1.52 95% CI 1.48-1.55), costs (p<0.001, aOR 1.61 95% CI 1.61-1.61) despite controlling for non-matched hospital variables. In this propensity score matched analysis, malnutrition is associated with increased postoperative mortality, LOS, and hospitalization costs in patients with gastric cancer undergoing gastric resection surgery.

ПРИМЕНЕНИЕ ТЕСТА УТЕЧКИ КРАСИТЕЛЯ ДЛЯ КОНТРОЛЯ ГЕРМЕТИЧНОСТИ ЖЕЛУДОЧНО-КИШЕЧНОГО ТРАКТА ПРИ БАРИАТРИЧЕСКИХ ОПЕРАЦИЯХ

The problem of obesity is widespread both in the Republic of Belarus and on a global scale. So, according to the WHO, 640 million people in the world suffer from obesity [6]. In the Republic of Belarus in 2015—2016.rasprostranennost' ozhireniya sredi vzroslogo naseleniya sostavlyala 24,5 % [5, 6]. Morbidnoye ozhireniye pri IMT &gt;40 kg/m2, ili &gt;35 kg/m2 pri nalichii soputstvuyushchey patologii, chasto okazyvayetsya refrakternym k konservativnym the prevalence of obesity among the adult population was 24.5 % [5, 6]. Morbid obesity with a BMI &gt;40 kg/m2, or &gt;35 kg/m2 in the presence of concomitant pathology, is often weight loss in patients is precisely surgical intervention [2]. Among the performed bariatric operations, interventions involving gastric resection or bypass surgery prevail. Thus, in the world, the share of gastric bypass surgery on a Roux-type loop is 41.9 %, sleeve gastrectomy is 32.6 %, and the share of mini-gastric bypass is 5.0 % [6]. One of the most common complications after the listed bariatric procedures is the failure of the gastric suture line or anastomoses. After gastric sleeve gastrectomy, the incidence of this complication reaches 3.9 %, and after Roux-en-Y loop gastric bypass surgery — up to 8 % [3,7]

Omental patch versus gastric resection for perforated gastric ulcer: Systematic review and meta-analysis for an unresolved debate

BackgroundPerforated gastric ulcers are surgical emergencies with paucity of data on the preferred treatment modality of resection versus omental patch. We aim to compare outcomes with ulcer repair and gastric resection surgeries in perforated gastric ulcers after systematic review of literature. MethodsA systematic literature search was performed for publications in PubMed Medline, Embase, and Cochrane Central Register of Controlled Trials. We included all studies which compared ulcer repair vesus gastric resection surgeries for perforated gastric ulcers. We excluded studies which did not separate outcomes gastric and duodenal ulcer perforations. ResultsThe search included nine single-institution retrospective reviews comparing ulcer repair (449 patients) versus gastric resection surgeries (212 patients). Meta-analysis was restricted to perforated gastric ulcers and excluded perforated duodenal ulcers. The majority of these studies did not control for baseline characteristics, and surgical strategies were often chosen in a non-randomized manner. All of the studies included were at high risk of bias. The overall odds ratio of mortality in ulcer repair surgery compared to gastric resection surgery was 1.79, with 95% CI 0.72 to 4.43 and p-value 0.209. ConclusionIn this meta-analysis, there was no difference in mortality between the two surgical groups. The overall equivalence of clinical outcomes suggests that gastric resection is a potentially viable alternative to ulcer repair surgery and should not be considered a secondary strategy. We would recommend a multicenter randomized control trial to evaluate the surgical approach that yields superior outcomes. Level of evidenceSystematic review and meta-analysis, level III.

Pathophysiology, prevention, and treatment of beriberi after gastric surgery.

Beriberi is a nutritional complication of gastric surgery, caused by deficiency of vitamin B1, or thiamine. Thiamine deficiency leads to impaired glucose metabolism, decreased delivery of oxygen by red blood cells, cardiac dysfunction, failure of neurotransmission, and neuronal death. This review describes the history and pathophysiology of beriberi as well as the relationship between beriberi and nutritional deficiencies after gastric surgery. A literature review of the history and pathophysiology of beriberi and the risk factors for thiamine deficiency, particularly after gastric resection or bariatric surgery, was performed. Recommendations for nutritional follow-up post gastric surgery are based on current national guidelines. Patients may have subclinical thiamine deficiency after upper gastrointestinal surgery, and thus beriberi may be precipitated by acute illness such as sepsis or poor dietary intake. This may occur very soon or many years after gastrectomy or bariatric surgery, even in apparently well-nourished patients. Prompt recognition and administration of supplemental thiamine can decrease morbidity and mortality in patients with beriberi. Dietary education post surgery and long-term follow-up to determine nutritional status, including vitamin and mineral assessment, is recommended for patients who undergo gastric surgery.

P158 RESULTS OF A NATIONAL SURVEY ABOUT PERIOPERATIVE CARE IN GASTRIC RESECTION SURGERY

Abstract Introduction Enhanced recovery after surgery programs in abdominal surgery are being established progressively. The aim of this study is to evaluate the application of different perioperative care measures in gastric surgery by Spanish surgeons. Methods A descriptive study of 162 surveys answered from September to December 2017 about the management and perioperative care in non-bariatric gastric resection surgery. Results Antibiotic and antithrombotic prophylaxis are always used by 96.9 and 99.4%, respectively; 62.7% recommend a fasting time for liquids greater than 6 hours and only 3% use preoperative carbohydrate drinks. Only 32.4 and 13.3% of subtotal and total gastrectomies are performed laparoscopically; 56.8% use epidural analgesia and drains are always placed by 53.8% in total gastrectomy. Nasogastric tubes are used selectively by 34.6% and always by 11.3%. Bladder catheters are removed during the first 48 hours by 77.2%. In the first 24 postoperative hours, less than 20% indicate oral intake and 15.4% mobilize their patients; 49.3% indicate walking after the first 24 hours; 30.4% apply a clinical pathway for the care of these patients and only 15.2% used an enhanced recovery after surgery protocol. Conclusions The implementation of enhanced recovery after surgery measures in nonbariatric gastric resection surgery is not widespread in our country.

Results of a National Survey About Perioperative Care in Gastric Resection Surgery

IntroductionEnhanced recovery after surgery programs in abdominal surgery are being established progressively. The aim of this study is to evaluate the application of different perioperative care measures in gastric surgery by Spanish surgeons. MethodsA descriptive study of 162 surveys answered from September to December 2017 about the management and perioperative care in non-bariatric gastric resection surgery. ResultsAntibiotic and antithrombotic prophylaxis are always used by 96.9 and 99.4%, respectively; 62.7% recommend a fasting time for liquids >6h and only 3% use preoperative carbohydrate drinks. Only 32.4 and 13.3% of subtotal and total gastrectomies are performed laparoscopically, respectively; 56.8% use epidural analgesia, and drains are always placed by 53.8% in total gastrectomy. Nasogastric tubes are used selectively by 34.6% and always by 11.3%. Bladder catheters are removed during the first 48h by 77.2%. In the first 24 postoperative hours, less than 20% indicate oral intake and 15.4% mobilize their patients; 49.3% indicate walking after the first 24h; 30.4% apply a clinical pathway for the care of these patients and only 15.2% used an enhanced recovery after surgery protocol. ConclusionsThe implementation of enhanced recovery after surgery measures in non-bariatric gastric resection surgery is not widespread in our country.

Resultados de la encuesta nacional sobre cuidados perioperatorios en cirugía resectiva gástrica

IntroductionEnhanced recovery after surgery programs in abdominal surgery are being established progressively. The aim of this study is to evaluate the application of different perioperative care measures in gastric surgery by Spanish surgeons. MethodsA descriptive study of 162 surveys answered from September to December 2017 about the management and perioperative care in non-bariatric gastric resection surgery. ResultsAntibiotic and antithrombotic prophylaxis are always used by 96.9 and 99.4%, respectively; 62.7% recommend a fasting time for liquids greater than 6hours and only 3% use preoperative carbohydrate drinks. Only 32.4 and 13.3% of subtotal and total gastrectomies are performed laparoscopically; 56.8% use epidural analgesia and drains are always placed by 53.8% in total gastrectomy. Nasogastric tubes are used selectively by 34.6% and always by 11.3%. Bladder catheters are removed during the first 48hours by 77.2%. In the first 24 postoperative hours, less than 20% indicate oral intake and 15.4% mobilize their patients; 49.3% indicate walking after the first 24hours; 30.4% apply a clinical pathway for the care of these patients and only 15.2% used an enhanced recovery after surgery protocol. ConclusionsThe implementation of enhanced recovery after surgery measures in non-bariatric gastric resection surgery is not widespread in our country.

NOB1 Gene as a Potential Biomarker in Clinical Outcomes and Prognosis of Patients with Gastric Cancer.

To investigate relationship of the Nin one binding protein (NOB1) gene with the prognosis of gastric cancer (GC). The GC tumor tissues and paired adjacent normal gastric tissues were collected from 65 patients who underwent primary gastric resection surgery in our hospital from January 2009 to July 2011. Data including age, gender, family cancer history, tumor diameter, pathological type, differentiation, clinical stage by tumor node metastasis (TNM) staging, lymphatic metastasis, and distant metastasis were collected. Expression of NOB1 and VEGF was determined using real time PCR. The relationship of NOB1 with clinical outcomes and prognosis of GC patients was analyzed by statistical methods. Both mRNA expression of NOB1 and VEGF was significantly higher in tumor tissues than that of the normal tissues, p < 0.05, and mRNA expression of NOB1 was positively correlated with mRNA expression of VEGF by Pearson's correlation analysis. Significant difference was observed in TNM stage, tumor differentiation, and metastasis between the low and high NOB1 expression groups, p < 0.05, while no significant difference was observed in age, gender, family cancer history, tumor location, and diameter. Univariate analysis showed that TNM stage, tumor differentiation, lymphatic metastasis, distant metastasis and expression of NOB1 and VEGF were all significantly different in survival and dead patients. Logistic analysis showed that NOB1 was an independent risk factor for 5-year mortality of GC patients, as well as lymphatic metastasis and distant metastasis. NOB1 was correlated with clinical outcomes and prognosis of GC patients and was an independent risk factor for 5-year mortality of GC patients. This study might provide more clinical evidences for NOB1 in GC and give a new target for diagnosis and treatment for GC patients.

P-133 - Outcomes of gastric cancer surgery in elderly patients

Introduction: Average life expectancy has been increasing in recent years. The average life expectancy at birth in Portugal was 80.64 years in 2015. The elderly population in Portugal grew 9% between 2011 and 2015, and if this growth rate is maintained in 2050 Portugal will have 4 million elderly people. The population over 80 years of age will double every 15 years according to demographic projections. As we know, gastric cancer is linked to environmental factors and genetic alterations. Thus the increase in the average life expectancy and in the percentage of elderly people also results in an increase in the incidence of gastric cancer in this population. This population is at higher risk of surgical complications and mortality, given the high number of comorbidities and often the surgery is avoided. Our objective is to assed surgical outcomes in gastric cancer patients older than 80 years by comparing clinicopathological characteristics and oncological/surgical outcomes between patients older than 80 and younger Methods: Retrospective analysis of a prospective database (n = 476) with gastric cancer cases submitted to curative intent surgery between January 2010 and December 2015, in a Upper GI Surgery Unit. After applying exclusion criteria we analyzed 248 patients. We analyzed the following variables: age, gender, co-morbidities, ASA score, clinical stage, T-stage, tumour size, surgery type, duration of surgery, lymphadenectomy type, histological type, venous invasion, lymphatic invasion, neural invasion, Lauren’s and Ming’s classification, tumour location, number of resected lymph nodes, perioperative blood transfusions, macroscopic type of tumour, length of hospital stay and complications. Results: The variables gender, presence of co-morbidities, ASA score, histological type, T-stage, tumour size, Ming’ classification, duration of surgery, type of surgery, number of lymph nodes ressected, type of lymphadenectomy, lymphatic invasion, perioperative blood transfusions and length of hospital stay were significantly different between the 2 groups. There were no statistically significant differences between the 2 groups for complications (including anastomotic leakage), late complications, mortality, readmission rate, surgical reintervention, recurrence rate, disease-free survival and disease-specific survival. Conclusion: Resection surgery in elderly patients with gastric cancer presents similar results to those of younger patients, either at the level of complications, mortality, recurrence rate, disease-free survival and disease-specific survival. Gastric resection surgery is a safe, feasible and effective treatment, so it has to be included in the therapeutic options for this age group.

Predictors of postoperative morbidity after cytoreduction for advanced ovarian cancer: Analysis and management of complications in upper abdominal surgery

ObjectiveTo evaluate the complication rate and its impact in patients who have undergone upper abdominal surgery for treatment of advanced ovarian cancer. MethodsPatients who have undergone upper abdominal surgery including diaphragm surgery, splenectomy, distal pancreatectomy, gastric resection, liver resection and biliary surgery were considered for the study. Perioperative complications were evaluated and graded according to Clavien–Dindo. ResultsOne hundred and twenty one patients were included. Two hundred and twelve surgical procedures were performed. Thirty-six patients reported at least one complication, but 61.1% of these the complication was mild. Median hospital stay for patients with and without complication was 7 vs. 13days respectively (p<0.001). There was a significant correlation between post-operative hospital stay and the total number of surgical procedures (R=0.445, p<0.001). At multivariate analysis, diaphragmatic resection and pancreatic resection were associated with a significant increase of postoperative hospital stay, furthermore diaphragmatic resection (p=0.004), hepatic resection (p=0.004), pancreatectomy (p=0.011) and biliary surgery (p=0.049) were independent predictors of severe (G3–G4) complication. ConclusionsRate of complications of patients submitted to upper abdominal surgery for ovarian cancer is acceptable. Prediction of severe complications is the goal for its optimal management. Extensive procedures should be avoided with those patients in which optimal residual tumor could not be reached.

Perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted gastric sleeve resection.

Purpose:One of the major advantages for patients undergoing minimally invasive surgery as compared to an open surgical procedure is the improved recovery profile and decreased opioid requirements in the perioperative period. There are no definitive studies comparing the analgesic requirements in patients undergoing two different types of minimally invasive procedure. This study retrospectively compares the perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted, laparoscopic gastric sleeve resection.Materials and Methods:With Institutional Review Board approval, the medication administration records of all severely obese patients who underwent gastric sleeve resection were retrospectively reviewed. Intra-operative analgesic and adjuvant medications administered, postoperative analgesic requirements, and visual analog pain scores were compared between those undergoing a laparoscopic procedure versus a robotic-assisted procedure.Results:This study cohort included a total of 28 patients who underwent gastric sleeve resection surgery with 14 patients in the laparoscopic group and 14 patients in the robotic-assisted group. Intra-operative adjuvant administration of both intravenous acetaminophen and ketorolac was similar in both groups. Patients in the robotic-assisted group required significantly less opioid during the intra-operative period as compared to patients in the laparoscopic group (0.15 ± 0.08 mg/kg vs. 0.19 ± 0.06 mg/kg morphine, P = 0.024). Cumulative opioid requirements for the first 72 postoperative h were similar in both the groups (0.64 ± 0.25 vs. 0.68 ± 0.27 mg/kg morphine, P = NS). No difference was noted in the postoperative pain scores.Conclusion:Although intraoperative opioid administration was lower in the robotic-assisted group, the postoperative opioid requirements, and the postoperative pain scores were similar in both groups.

Reduction in gastric cancer surgical mortality over 10 years: An adverse events analysis.

BackgroundThe reduction in gastric cancer mortality is due to a reduction in incidence and of surgical mortality. This study was to examine adverse events in patients with gastric cancer dying under surgical care.MethodsAdverse events in surgical care were prospectively audited in patients who died of gastric cancer in Scottish hospitals. A cohort retrospective study examining deaths and contributing adverse events was compared for the periods 1996–2000 and 2001–2005.ResultsBetween 1996 and 2005, 1083 patients with gastric cancer died on surgical wards in Scottish hospitals. The annual number of deaths under surgical care fell significantly from an average of 128 deaths per annum in years 1996–2000 to 88 deaths per annum in 2001–2005 (p < 0.001). This occurred in parallel with the decline in gastric cancer incidence over the same period. There was an increase in the proportion of gastric cancer resections carried out in 7 major hospitals in Scotland in the second period of the study (p < 0.001). The mean number of deaths in the group of patients, who had gastric cancer resection and palliative surgery, were significantly lower in the second period of the study In addition, when all patients were considered as a group, the mean number of anaesthetic, critical care, medical management and technical surgery adverse events were significantly lower in the second study period.ConclusionThere has been a reduction in deaths and adverse events for patients with gastric cancer under surgical care and this has been associated with surgical subspecialisation in oesophago-gastric cancer surgery.

The role of duodenogastric reflux in formation of precarcinogenic gastric lesions: An experimental study

Duodenogastric reflux, commonly encountered as an aftermath of gastroenteroanastomosis, with or without gastric resection (Billroth I, Billroth II), vagotomy and pyloroplastic surgery, is known to cause inflammatory-dystrophic-metaplastic lesions of gastric mucosa. Our objective was to determine the effects of surgery-induced duodenogastric reflux on the development of precarcinogenic lesions or carcinoma in correlation with the reflux duration. The experiment was performed on three groups of Wistar rats with 1) Billroth II-induced reflux surgery, 2) resection of the Rouxr-en-Y type reconstruction, and 3) control group with no resection. The aim of the experiment was to study the effects ofduodenogastric reflux on the rat gastric mucosa in correlation with two different types of gastroenteroanastomosis 8, 16 and 24 weeks after the surgery. In Billroth II group, hyperplastic changes were observed as early as in week 16. Statistically significant results were recorded in week 24, with 6.7% of metaplastic alterations, including dysplasia of all three degrees, dominantly severe dysplasia in 66.67%, early carcinoma in 20% and gastric carcinoma in 6.67%. In the Roux-en-Y group, gastric mucosa remained predominantly normal (60%), with somewhat increased frequency ofgastritis and dysplasia in week 24. In the control group, the finding of normal gastric mucosa was constant. The experiment confirms that direct contact of duodenal juice with gastric mucosa associated with Billroth II resection causes precarcinogenic lesions. Development of adenocarcinoma caused solely by duodenogastric reflux, excluding a carcinogenic agent is possible 20 weeks after the experiment--earlier than suggested by previous researchers.

Chemotherapy for operable gastric cancer: current perspectives.

The majority of gastric cancer patients present with advanced, incurable disease and only a minority have localised disease that is suitable for radical treatment. A benefit has generally been demonstrated from adding chemotherapy to surgery for early disease though there are marked differences in how this is done globally. Whilst a perioperative approach, with chemotherapy given before and after gastric surgery is commonly used in the Europe and Australia most patients with operable gastric cancer in North America are treated with surgery and postoperative chemoradiation. In contrast, in East Asia, adjuvant fluoropyrimidine chemotherapy alone is used following D2 gastric resection surgery. However, despite the multimodality treatments, outcomes remain suboptimal as the majority of those treated for localised disease eventually relapse with incurable loco-regional or distant metastases. At the current time, an unmet need exists to further understand the biology of this aggressive disease and develop more efficacious therapies that can improve outcomes from this aggressive disease.

Gastric bezoars: reassessment of clinical and radiographic findings in 19 patients

The aim of this study was to reassess the clinical and radiographic findings in a series of patients with gastric bezoars. Radiology files revealed 19 patients with bezoars; 10 patients had CT and 10 had endoscopy before or after the barium studies. 11 patients (58%) had risk factors for gastroparesis and 6 (32%) had had previous gastric surgery, including 3 having had a gastric bypass or vertical banded gastroplasty. 18 patients (95%) had symptoms; in 10 of those patients, symptoms were present for 1 week or less (53%). On barium studies, the bezoars were round or ovoid in 17 patients (89%) and irregular in 2 (11%); mottled in 10 (53%) and homogeneous in 9 (47%); and mobile in 15 (79%) and immobile in 4 (21%). Gastroparesis was observed at fluoroscopy in 8 (62%) out of 13 patients without gastric surgery. Symptoms improved/resolved in 12 (67%) out of 18 patients. Follow-up CT or endoscopy showed resolution of the bezoars in 8 (80%) out of 10 patients; the mean interval to resolution was 12 days. Our experience suggests that gastroparesis is the single most common cause of bezoars, accounting for the majority of cases. Partial gastric resection or bariatric surgery should also be recognized as a cause of bezoar formation. These lesions may be manifested on barium studies by a spectrum of findings, appearing as mottled or homogeneous, mobile or immobile masses, sometimes filling the gastric pouch after bariatric surgery. Affected individuals often have an acute clinical presentation with symptoms for 1 week or less, and some bezoars resolve rapidly on conservative medical treatment.

A Modified Umbilical Incision for Specimen Extraction After Laparoscopic Abdominal Surgery

One advantage of laparoscopic surgery over open surgery is the absence of laparotomic incisions. This advantage is reduced when an auxiliary incision is performed to remove surgical specimens larger than the trocar. A special incision was performed at umbilical trocar level that enabled removal of a large surgical specimen as in right hemicolectomy (colic), gastric resection, and splenic surgery. The authors have used this method routinely for 10 years for all cases requiring removal of a surgical specimen too large for the normal incision of a 10-mm trocar. The authors maintain that this method avoids the use of auxiliary incisions, which undo the many benefits of laparoscopic surgery.

Nutritional status and dietary assessment of patients with gastrectomy

Nutrition is a crucial factor in gastric resection surgery and the most suitable alimentary canal reconstruction method must be considered in order to reduce the risk of malnutrition. The cause of postgastrectomy malnutrition has not been clearly determined, but the mechanisms behind malnutrition are evidently multifactorial. To evaluate the nutritional status of patients who underwent different reconstructive procedures after total or subtotal gastrectomy. Fifty patients who have undergone gastrectomy for 0.5-39 years were assessed. The surgical procedures used were Billroth I in 7, Billroth II in 26, Henley in 3 and Roux-en-Y in 14 of the patients. Twenty one of them have followed gastrectomy for cancer. The nutritional status was evaluated by subjective global assessment, dietary recall and anthropometry. According to subjective global assessment, 6 of 50 patients were mild malnourished. The mean body mass index was 22 4.75 kg/m2, the average daily calorie intake was 1624 477 Kcal. Of the patients operated for cancer, those who underwent subtotal gastrectomy followed by Roux-en-Y presented higher body mass index. No relationship between the period of time since surgery with body mass index or with calorie intake was found. Among patients operated for cancer, subtotal gastrectomy with Roux-en-Y reconstruction is associated with better nutritional status. Factors other than low calorie intake are the cause of weight loss in patients with gastrectomy.