Postoperative Gastric Emptying Research Articles

The benefits of R anastomotic technique for Billroth-II reconstruction with Braun anastomosis during totally laparoscopic distal gastrectomy: a propensity score matching analysis.

Currently, there is no consensus on the most appropriate anastomotic site, anastomotic line, and direction for Billroth-II reconstruction with Braun anastomosis (B-II-B anastomosis) during totally laparoscopic distal gastrectomy (TLDG). Herein, the authors presented a novel anastomotic technique called R anastomosis for B-II-B anastomosis and compared it with the conventional B-II-B anastomosis technique to assess its feasibility, safety, and effectiveness. Between March 2019 and September 2022 in our centre, R anastomosis was performed on 123 patients undergoing TLDG for distal gastric cancer. A retrospective review of a prospectively collected database identified patients who underwent TLDG between January 2010 and September 2022. Patients who underwent R anastomosis were matched in a 1:1 ratio with patients who underwent conventional anastomosis using a propensity score based on age, sex, preoperative BMI, American Society of Anesthesiologists (ASA) score, and the history of abdominal surgery. Surgical and postoperative outcomes and clinicopathological data were analyzed for both groups. During the study period, 246 patients were included, 123 in each group. No intraoperative complications associated with digestive tract reconstruction and no cases of conversion to open surgery were reported in either group; furthermore, no incidences of perioperative mortality were noted in either group. The R group had a significantly reduced anastomotic time compared to the control group (30 ± 4.1 vs. 36 ± 5.3 min, P < 0.001). Perioperatively, the incidences of Clavien-Dindo grade II or higher complications were 6.5% (8/123) and 12.2% (15/123) in the R and control groups with no significant difference between the two groups. Postoperative gastric emptying dysfunction was found in five and one patient in the control and R groups, respectively. R anastomosis is a safe and effective technique for B-II-B anastomosis following TLDG. This novel technique enhances the convenience of performing anastomosis and can reduce postoperative gastric emptying dysfunction.

Predictors of favorable outcome after pyloroplasty for gastroparesis: should response to pyloric dilation or Botox injection be used as a marker of surgical outcome?

IntroductionPyloroplasty and gastric peroral endoscopic myotomy (G-POEM) are effective surgeries for gastroparesis. The primary aim of this study was to evaluate outcomes of pyloroplasty and G-POEM in patients with gastroparesis and determine factors associated with favorable outcome. The secondary aim was to assess the utility of clinical response to preoperative pyloric dilation or botulinum toxin injection (Botox) on surgical outcome, a factor conventionally used as a favorable marker.MethodsThere were 204 patients who underwent pyloroplasty (n = 177) or G-POEM (n = 27) for gastroparesis at our institution from 2014 to 2021. Demographic and clinical parameters were analyzed to assess their impact on surgical outcome. A subgroup of patients who had pyloric dilation or Botox injection were assessed separately. Favorable outcome was defined as patient reported complete resolution of the predominant gastroparesis symptom.ResultsFavorable outcome was achieved in 78.4% of patients (pyloroplasty: 79.7% and G-POEM: 70.4%, p = 0.274). Among 61 patients where pre- and postoperative gastric emptying studies (GES) were available, mean 4-hour retention significantly improved from 33.5 to 15.0% (p < 0.001) and 77.0% of patients achieved normalization.Favorable outcome was not significantly impacted by etiology of gastroparesis (p = 0.120), GERD (p = 0.518), or primary gastroparesis symptom (p = 0.244). Age ≥ 40 was a significant predictor of favorable surgical outcome on multivariate analysis [OR: 2.476 (1.224–5.008), p = 0.012]. Among the patients who had preoperative dilation (n = 82) or Botox injection (n = 46), response to these interventions was not a predictor of favorable surgical outcome (p = 0.192 and 0.979, respectively). However, preoperative Botox injection, regardless of response to injection, was associated with favorable surgical outcome [OR: 3.205 (CI 1.105–9.299), p = 0.032].ConclusionSymptomatic improvement after pyloroplasty or G-POEM is independent of etiology of gastroparesis, GERD, and primary symptom. Response to dilation or Botox are not markers of response to surgery. However, patients who receive Botox are 3.2 times more likely to improve postoperatively.Graphical abstract

Retrospective Analysis of 128 Patients of Acupuncture Consultation After Pancreatic Surgery

Abstract?Objective: To analyze and summarie the the current situation of acupuncture consultation of postoperative patients for pancreatic caner in Qilu hospital of Shandong University and provide reference for acupuncture treatment of postoperative complications after pancreatic surgery.effect of acupuncture in treating gastrointestinal dysfunction after pancreatic surgery.Methods: Consultation reasons, diagnosis, treatments, patient compliance and effect of 128 cases from October 9,2020 to October 9,2021 was statistical analyzed. Result? A total of 128 patients were involved, 116 of those were completely treated. Effective rate of acupuncture for early postoperative inflammatory bowel obstruction was 94.85 % ?for postoperative gastric emptying dysfunction was 81.25% ? for early postoperative inflammatory bowel obstruction with gastric emptying disorder was 66.67 %and clinical total effective rate was 91.38 %.Conclusion: Acupuncture can promote pancreatic gastrointestinal function rehabilitation and provide new methods for enhanced recovery after surgery concept.

Endoscopic findings do not predict per-oral pyloromyotomy (POP) response.

Gastroparesis is a life-altering diagnosis caused by the stomach's inability to function in the absence of a mechanical obstruction. The primary causes are idiopathic, diabetic, and postoperative. Our first-line treatment for medical refractory gastroparesis is the endoscopic per-oral pyloromyotomy (POP) procedure. Predicting clinical response cost effectively remains elusive. All patients who underwent a POP procedure at our institution by a single surgical endoscopist from January 1, 2019 to June 30, 2020 were retrospectively reviewed. All endoscopic data were prospectively collected. The patients were followed by a survey including the Gastroparesis Cardinal Symptom Index (GCSI) and other relevant postoperative measures. The primary endpoint was clinical response defined as ≥ 1.0 decrease in the GCSI from preoperative to the time of survey. Secondary outcome was normalization of the gastric emptying study (GES). Our patient population is 85% female and has an average age of 44.8years. The diagnosis of gastroparesis is 71% iatrogenic, 19% postoperative, and 10% diabetic. On endoscopy, 30% had bile in the stomach and 65% had any degree of pylorospasm. The primary outcome measure of clinical response was 39% at an average of 697 ± 151days post-POP, but 66% of patients attested to an improvement in their symptoms. Of 68 postoperative gastric emptying studies 50% normalized at an average of 145 ± 98days. Following univariate and multivariate analyses of preoperative data and endoscopic findings, there were no significant predictors of clinical response. A preoperative GCSI ≥ 2.6 trends toward significance (OR 6.87, p = 0.058). Endoscopic findings at the time of POP do not correlate with clinical response. The GCSI model currently used to measure clinical response may not accurately capture the full clinical picture. The long-term durability of endoscopic myotomy to treat medical refractory gastroparesis needs to be studied further to improve patient selection.

G-POEM - Gastric Peroral Endoscopic Myotomy as a Therapy Option for Chronic Gastric Emptying Disorders

Many doctors and patients shy away from the surgical intervention of a pyloromyotomy using laparoscopy. The effectiveness of botulinum toxin injections into the pylorus has not been established 1 2. Pharmacological therapeutic approaches are unsatisfactory and show a wide range of side effects 3. G-POEM is a procedure that has proven its feasibility with a low complication rate. A relatively high response could be documented in previous publications 4. The long-term successes are still being discussed controversially 5. After the initial euphoria, the problem of patient selection comes to the fore. The symptoms, as well as the pathophysiology of gastric emptying disorder, are diverse 6. The diagnostic tests available do not reflect the variability of the disease 7 8 9 10. The postoperative gastric emptying disorder seems to be an exception. G-POEM can protect both therapists and patients from another invasive procedure.

Meta-analysis of the efficacy of Da Vinci robotic or laparoscopic distal subtotal gastrectomy in patients with gastric cancer.

Background:Robotic-assisted gastrectomy has been used for treating gastric cancer since 2002. This meta-analysis was conducted to systematically evaluate the efficacy of Da Vinci robotic distal subtotal gastrectomy (RDG) or laparoscopic distal subtotal gastrectomy (LDG) in patients with gastric cancer.Methods:We conducted searches in domestic and foreign databases, and collected literature in Chinese and English on the efficacy of RDG and LDG for gastric cancer that have been published since the inception of the database. RevMan 5.4.1 was used for meta-analysis and drawing and Stata14.0 was used for publication bias analysis.Results:A total of 3293 patients in 15 studies were included, including 1193 patients in the RDG group and 2100 patients in the LDG groups respectively. The meta-analysis showed that intraoperative blood loss was significantly lower and the number of resected lymph nodes was higher in the RDG group compared to that in the LDG group. In addition, the times to first postoperative food intake and postoperative hospital stay were shortened, and there was a longer length of distal resection margin and prolonged duration of operation. No significant differences were found between the 2 groups with respect to the first postoperative anal exhaust time, length of proximal resection margin, total postoperative complication rate, postoperative anastomotic leakage rate, incidence of postoperative gastric emptying disorder, pancreatic fistula rate, recurrence rate, and mortality rate.Conclusion:RDG is a safe and feasible treatment option for gastric cancer, and it is non-inferior or even superior to LDG with respect to therapeutic efficacy and radical treatment.

Rapid Liquid Phase Gastric Emptying May Be The Harbinger Of Sustained Weight Loss After Laparoscopic Sleeve Gastrectomy

Study Contextual: 15-20 % Of laparoscopic sleeve gastrectomy patients need revisional surgery after LSG, because of inadequate weight loss. Aim: The aim of our study is, primarily to analyze the relationship between liquid-phase gastric emptying rate and weight loss, to find a parameter that may be the harbinger of successful weight loss after LSG. Methods: Patient records who have undergone laparoscopic sleeve gastrectomy were examined retrospectively. 44 Patients were included in the study. Preoperative weight and BMI, postoperative weight loss at first, third, and sixth months, surgical operation reports, preoperative and postoperative liquid-phase gastric emptying study values were mainly collected. Results: The male/ female ratio was 18/82. Mean age 38 (19-60), mean body mass index 48,1(40-66) kg/m² and mean (EWL%) 63,17±13,94 were found. Mean pre and post-operative gastric emptying half times were found to be (T½) 41,86 minute(min), T½ 6,82 min (p&lt;0.0001). Significant correlation was found between patients’ post-operative third and sixth month EWL% and post-operative T½ (p=0,020, p=0,032). Patients who have post-op gastric T½ above 10 min had decreased sixth-month EWL% significantly (p=0.03). Conclusion: Post-operative gastric emptying time (T½) may be a harbinger of weight loss after LSG.

Gastric Peroral Endoscopic Myotomy: A Specific Learning Curve.

Gastric peroral endoscopic pyloromyotomy (G-POEM) is a novel option for patients with gastroparesis. It involves submucosal tunneling across the pylorus, followed by pyloromyotomy, and subsequent closure of the endoscopic tunnel. The aim of this study was to determine the learning curve for G-POEM. Consecutive patients undergoing G-POEM by a single operator were included from a prospective registry over 2 years. Demographics, procedure info, postprocedure follow-up data, and adverse events were collected. Nonlinear regression and cumulative sum control chart analyses were conducted for the learning curve. Clinical outcomes were improvement in Gastroparesis Cardinal Symptom Index score and gastric emptying scintigraphy. Thirty-six patients were included (16.7% M, mean age 46 y). The majority had idiopathic gastroparesis (n=16, 44%), with the remaining having diabetes (n=5, 17%), postsurgical (n=10, 28%), or other (n=4, 11%). Technical success was achieved in 35 of 36 (97%). There was a significant reduction in the total Gastroparesis Cardinal Symptom Index score (2.09 units, P<0.00001) and a significant reduction in postoperative gastric emptying scintigraphy (82.44 mins, P<0.00001). Mean follow-up was 15 months (SD, 1.05). Median procedure time was 60.5 minutes (range, 35 to 136). Cumulative sum control chart shows 60-minute procedure was achieved at the 18th procedure. Procedure durations further reduced with consequent procedures with the last 3 being 45 minutes, thus demonstrating continued improvement with ongoing experience (nonlinear regression P<0.0001). Endoscopists experienced in G-POEM are expected to achieve a reduction in procedure time over successive cases, with efficiency reached at 60.5 minutes and a learning rate of 18 cases with continuing improvement.

Differential gastric emptiness according to preoperative stomach position in neurological impaired patients who underwent laparoscopic fundoplication and gastrostomy.

We sometimes experienced prolonged delayed gastric emptying (DGE) in neurologically impaired patients undergoing laparoscopic fundoplication and gastrostomy. We explored the difference in the DGE rate according to the preoperative stomach position. Thirty-two neurological impaired patients who underwent laparoscopic fundoplication and gastrostomy between 2015 and 2019 were classified into two groups based on stomach position: non-elevated stomach position (NESP) and elevated stomach position (ESP). Patients' characteristics, operative result and postoperative gastric emptying were reviewed. The 11 ESP patients were significantly older than the 21 NESP patients (p < 0.05). The ESP patients had a significantly heavier body weight (BW) than the NESP patients (p < 0.05). The time taken (days) to reduce gastric drainage (days, below BW × 10ml) in the NESP (4.3 ± 3.6) was significantly longer than that of ESP (1.3 ± 1.6) (p < 0.05). The time taken (days) to achieve full enteral nutrition in the NESP (14.1 ± 8.9) was significantly longer than that of the ESP patients (8.8 ± 3.1) (p < 0.05). Elevated stomach position (ESP) patients archived full enteral nutrition earlier than NESP patients after laparoscopic fundoplication and gastrostomy. Stomach position correction might, therefore, be involved in the incidence of DGE.

Preliminary efficacy analysis of Cheng's Giraffe reconstruction after proximal gastrectomy in adenocarcinoma of esophagogastric junction

Objective: To investigate the safety and feasibility of proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction for the treatment of early Siewert II adenocarcinoma of esophagogastric junction (AEG). Methods: Indication of Cheng's Giraffe esophagogastric reconstruction: (1) Siewert II AEG or Siewert III AEG with diameter < 4 cm; (2) preoperative staging as cT1-2N0M0. A descriptive case series study was carried out. Clinical data of 34 patients with Siewert II AEG undergoing proximal partial gastrectomy and Cheng's Giraffe esophagogastric reconstruction at Department of Abdominal Surgery of Zhejiang Cancer Hospital and Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from February to July 2018 were retrospectively collected and analyzed, including 14 cases in IA stage, 11 cases in IIA stage and 8 cases in IIB stage. Brief procedure of Cheng's Giraffe esophagogastric reconstruction was as follows: Firstly, 12 cm long tubular stomach was formed by longitudinal incision 4 cm away from the great curvature of the stomach. Secondly, the gastric fundus and His angle were formed. Finally, the distance from His angle to esophagal-tubular gastric anastomosis should be more than 5 cm. The reflux disease questionare (RDQ) scores, radionuclide gastric emptying scintigraphy, and 24-hour multichannel intraluminal (MII)-pH monitoring technology were used to evaluate postoperative gastric emptying and gastroesophageal reflux. Result: All 34 patients successfully completed proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction, including 13 cases by open surgery and 21 cases by laparoscopic surgery. The operation time was (144.6±39.8) minutes, the blood loss during operation was (35.4±17.2) ml. No laparoscopic case was converted to open surgery and no postoperative complication was observed. The postoperative hospital stay was (8.4±2.5) days. The postoperative RDQ score was 4.4±3.1 one month after operation, and 3.3±2.5 six months after operation. Gastric-half emptying time was (67.0±21.5) minutes, and the residual ratio was (52.2±7.7)% in 1 hour, (36.4±3.1)% in 2 hours and (28.8±3.6)% in 3 hours at postoperative 1-month. The 24-hour MII-pH monitoring at postoperative 2-month revealed the frequency of acid reflux was (12.6±7.9) times, frequency of non-acid reflux was (19.6±9.7) times, DeMeester score was 5.8±2.9. Conclusion: Cheng's Giraffe esophagogastric reconstruction is safe and feasible in the treatment of Siewert type II AEG, and has good dynamic and anti-reflux effects.

Scintigraphic evaluation of gastric emptying after greater curvature plication in comparison with sleeve gastrectomy

Introduction: Laparoscopic gastric plication (LGP) is a relatively new restrictive bariatric procedure that emerged to avoid the problems and to reduce the cost of laparoscopic sleeve gastrectomy. In this study we present the initial short-term outcome of LGP and its effect on gastric emptying and compare it with the results of laparoscopic sleeve gastrectomy (LSG). Methods: From May 2016 to April 2017, a total of 50 patients were allocated to undergo either LGP (n = 25) or LSG (n = 25). Data on the operative time, complications, hospital stay, overall cost of LSG and LGCP, body mass index loss (BMIL), post-operative gastric emptying (the first study to asses gastric emptying after LGP), percentage of excess weight loss (%EWL), and improvement of comorbidities were collected during the follow-up examinations. Results: All procedures were completed laparoscopically. The mean operative time was significantly higher for the LGP group. The mean hospital stay, cost and %EWL were significantly higher in the LSG group. The mean gastric emptying t1/2 was 40 ± 13 minutes for LGP group and 28.3 ± 8.31 minutes for LSG group (P = 0.001). Conclusion: There is significant acceleration of gastric emptying after LSG more than after LGP with significant effect on weight loss.

Abnormal Gastric Emptying is Common After Nissen Fundoplication

Introduction: Surgical fundoplication is often performed for gastroesophageal (GERD) symptoms not fully responsive to anti-secretory therapy; however, a subset of patients develop gas/bloat and dyspeptic symptoms following surgery. The effects on gastric motility following surgical fundoplication are poorly documented. A few proposed mechanisms have included impaired post-prandial fundic accommodation and vagal nerve injury. The aim of this study is to analyze the effect of Nissen fundoplication on gastric emptying. Methods: Patients who underwent Nissen fundoplication at Cleveland Clinic between March 2001 to December 2013 and had both pre- and post-operative gastric emptying scintigraphy (GES) available were reviewed. GES was performed using the standardized protocol of oral ingestion of 1 millicuries of 99m technetium sulfur colloid mixed with a standardized egg meal followed by imaging over the abdomen being obtained in the anterior and posterior projections at 0, 1, 2 and 4 hours post ingestion. Patients with less than 30% gastric retention at 1 hour were recognized as having rapid gastric emptying; retention of >10% at four hours were diagnosed with gastroparesis. Data were analyzed using SPSS version 20 (SPSS Inc, Chicago, IL). Continuous variable were expressed as means and standard deviation and categorical variables expressed as percentages.Table: Table. Change in gastric emptying post Nissen FundoplicationResults: 97 patients were included for review. Prior to surgery, 70 patients had normal emptying, 20 with delayed and 5 with rapid gastric emptying. The clinical profiles and surgical variables of these patients are detailed in Table 1. Our review revealed a significant increase in the number of patients with abnormal gastric emptying post-surgery, with the increase in gastroparesis from 22.7 to 32.0% and rapid gastric emptying from 5.2 to 10.3%.Table: Table. Patient characteristics at the time of Nissen FundoplicationConclusion: In patients with dyspeptic symptoms following Nissen fundoplication, both delayed and rapid gastric emptying must be considered as a potential etiology. In this study, 42.3% of patients had abnormal gastric emptying after fundoplication, compared to 28% before surgery. Further research is warranted regarding the pathophysiology and treatment of both rapid and delayed gastric emptying after fundoplication.

Pylorus-Preserving Pancreaticoduodenectomy: Evaluation of 50 Cases

Introduction: Pancreaticoduodenectomy is the procedure of choice for periampullary neoplasms. It is considered as a major surgical procedure. It is associated with relatively higher postoperative mortality and morbidity rate, however, with development of technology, proper patient selection, meticulous operative technique, appropriate postoperative care, morbidity and mortality rate has decreased subsequently. Up to the 1970s, the operative mortality rate after pancreaticoduodenectomy approached 20% but it has been reduced to less than 5% in recent reports. This study is designed to evaluate the postoperative outcomes of pylorus-preserving pancreaticoduodenectomy procedure in our set up.&#x0D; Objective: To evaluate the outcome of the pylorus-preserving pancreaticoduodenectomy procedure with the intention to measure operation time and per-operative bleeding, observing postoperative anastomotic leakage and gastric emptying time. To find out postoperative wound infection and complications to detect the dumping syndrome.&#x0D; Materials and Methods: A prospective observational study was carried out in the Department of Hepatobiliary Surgery, Combined Military Hospital, Dhaka from July 2013 to January 2017. Fifty patients who underwent pylorus-preserving pancreaticodudenectomy procedure were included in this study.&#x0D; Results: Out of 50 postoperative patients, 12(24%) patients developed complications. Of these patients, 3(6%) developed wound infection, 2(4%) developed bile leakage and 2(4%) developed postoperative haemorrhage. Pancreatic fistula, vomiting, delayed gastric emptying and abdominal collection all were 1(2%) each. Postoperative mortality was 3(6%).&#x0D; Conclusion: The present study demonstrated the development of postoperative complications after pylorus-preserving pancreaticoduodenectomy is as similar as published in different studies. Better outcome can be achieved with meticulous pre-operative evaluation of risk factors and per-operative skill maneuvering.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 42-45

Efficacy analysis of laparoscopy-assisted pylorus-vagus nerve preserving gastrectomy in the treatment of early middle gastric cancer

To compare the efficacy and safety of laparoscopy-assisted pylorus-vagus nerve preserving gastrectomy (LAPPG) and laparoscopy-assisted distal gastrectomy (LADG) in order to evaluate the feasibility of LAPPG in the treatment of early middle gastric cancer. Clinical and follow-up data of 60 patients with early middle gastric cancer undergoing laparoscopic operation in The First Affiliated Hospital of Dalian Medical University from September 2003 to July 2010 were analyzed retrospectively, including 35 patients with LAPPG and 25 with LADG. Operation time, blood loss, postoperative complications, postoperative nutritional status and long-term survival were compared between two groups. There were no significant differences in baseline information between the two groups. Distal resection margin distance of LAPPG group was significantly shorter than that of LADG group [(2.64±1.29) cm vs. (4.66±2.01) cm, P=0.001], while operative time, blood loss, and number of harvested lymph node were not significantly different between the two groups (all P>0.05). In LAPPG group, ratio of delayed gastric emptying was significantly higher [28.6%(10/35) vs. 8.0%(2/25), P=0.046] and ratio of acid reflux was significantly lower [0 vs. 20.0%(5/25), P=0.038] as compared to LADG group, while postoperative complications, body weight and serum albumin level were not significantly different between the two groups (all P>0.05). Postoperative overall 5-year survival rate was 91.1% and 90.3% in LAPPG and LADG group respectively without significant difference (P=0.704). LAPPG can effectively control the velocity of postoperative gastric emptying and decrease gastric reflux without affecting oncologic efficacy, which is a good choice in the treatment of early middle gastric cancer.

Effect of Vagus Nerve Integrity on Short and Long-Term Efficacy of Antireflux Surgery.

Vagus nerve injury is a feared complication of antireflux surgery (ARS) that may negatively affect reflux control. The aim of the present prospective study was to evaluate short-term and long-term impact of vagus nerve injury, evaluated by pancreatic polypeptide response to insulin-induced hypoglycemia (PP-IH), on the outcome of ARS. In the period from 1990 until 2000, 125 patients with gastroesophageal reflux disease (GERD) underwent ARS at a single center. Before and 6 months after surgery, vagus nerve integrity testing (PP-IH), 24-h pH-monitoring, gastric emptying, and reflux-associated symptoms were evaluated. In 2014, 14-25 years after surgery, 110 patients were contacted again for evaluation of long-term symptomatic outcome using two validated questionnaires (Gastrointestinal Symptom Rating Scale (GSRS) and GERD-Health Related Quality of Life (HRQL)). Short-term follow-up: vagus nerve injury (PP peak ≤47 pmol/l) was observed in 23 patients (18%) 6 months after fundoplication. In both groups, a comparable decrease in reflux parameters and symptoms was observed at 6-month follow-up. Postoperative gastric emptying was significantly delayed in the vagus nerve injury group compared with the vagus nerve intact group. Long-term follow-up: patients with vagus nerve injury showed significantly less effective reflux control and a higher re-operation rate. Vagus nerve injury occurs in up to 20% of patients after ARS. Reflux control 6 months after surgery was not affected by vagus nerve injury. However, long-term follow-up showed a negative effect on reflux symptom control and re-operation rate in patients with vagus nerve injury.

Examination of the Relationship Between Postoperative Quality of Life and Gastric Emptying Function After Pylorus-Preserving Gastrectomy and Distal Gastrectomy

The objective of this study was to compare postoperative quality of life (QOL) of patients with early cancer of the body of the stomach who were treated with pylorus-preserving gastrectomy (PPG) and those treated with distal gastrectomy (DGR), and to evaluate the relationship between postoperative QOL and gastric emptying function (GEF). Patients with early cancer of the body of the stomach are often treated with PPG to preserve gastric function, and their QOL appears to be better after PPG than after DGR. Differences in postoperative GEF are thought to be a factor, but the relationship between GEF and postoperative QOL has not been well investigated. A total of 60 patients [23 PPG and 37 DGR (Billroth I)] completed QOL surveys [SF-36, Gastrointestinal Symptom Rating Scale (GSRS)] and underwent 13C-breath tests to evaluate GEF in two groups (≤12 months postoperatively and &amp;gt;12 months postoperatively). The time until the percentage of breath 13CO2 reaches a peak during the 13C-breath test (Tmax), which is an index of gastric emptying velocity, was evaluated. For the SF-36, there were no significant differences between the two procedures. For GSRS, a trend toward better scores was seen after PPG; abdominal pain and total scores at &amp;gt;12 months postoperatively were significantly better with PPG. Tmax was significantly longer for PPG patients. For each procedure, symptoms significantly worsened when Tmax was &amp;lt;21 minutes at &amp;gt;12 months after surgery. Although postoperative GEF evaluated by 13C-breath tests did not affect overall QOL measured by the SF-36, it did affect disease-specific QOL measured by GSRS.

Pyloric reconstruction for refractory dumping syndrome after Nissen fundoplication and pyloroplasty in an infant: A case report

Abstract Dumping syndrome (DS) is common after gastrectomy or gastric bypass surgery, but DS in children has been described almost exclusively as a complication of Nissen fundoplication. DS resolves spontaneously in most patients; however some patients require dietary modification or medications, and surgical treatment is reserved for medically intractable cases. We herein describe an unusual case of DS in a neurologically impaired infant that developed after Nissen fundoplication and pyloroplasty and was treated by reversal of the pyloroplasty. A 12-month-old male infant was referred for medically intractable DS. He suffered from cerebral palsy and gastroesophageal reflux and underwent open Nissen fundoplication, gastrostomy tube placement, truncal vagotomy, and pyloroplasty two months before referral. Gastric emptying scintigraphy confirmed rapid gastric emptying, which was consistent with early DS. On laparotomy, a pyloroplasty scar was identified and opened along the scar. The pyloric ring was identified, reapproximated, and the incision was closed longitudinally. Postoperative gastric emptying scan showed normalized gastric emptying, and the half-emptying time was measured as 110 min. Pyloric reconstruction is a technically easy and less destructive surgery and should be considered as a therapeutic option in medically refractory DS following fundoplication and pyloroplasty.

Pyloroplasty for Refractory Gastroparesis

Gastroparesis is a chronic gastric motility disorder in which the pathophysiology mimics a postvagotomy state. Pyloroplasty is beginning to emerge as a successful drainage procedure for refractory gastroparesis. Here we report our experience using pyloroplasty in the surgical management of diabetic and nondiabetic gastroparesis. A retrospective study was performed of 46 patients undergoing pyloroplasty for refractory gastroparesis from January 2010 through December 2013. Gastric emptying scintigraphy and the Gastroparesis Cardinal Symptom Index were assessed pre- and postoperatively. Laparoscopic pyloroplasty was performed in 42 patients, open pyloroplasty in three, and one patient was converted from laparoscopic to open pyloroplasty. Studies were repeated during the six to 12 month postoperative interval. The postoperative gastric emptying scintigraphy improved in 90 per cent of patients and normalized in 60 per cent. Postoperative T½ was significantly reduced (P = 0.001) as was four-hour retention (P < 0.001). The Gastroparesis Cardinal Symptom Index showed statistically significant reduction in symptom severity for all nine categories (P < 0.0005) as well as total symptom score (P < 0.005). No patients developed dumping syndrome. Pyloroplasty is a highly effective therapy for refractory gastroparesis, offering significant reduction in symptom severity, improvement in quality of life, and acceleration of gastric emptying.

Prospective randomized clinical trial of a change in gastric emptying and nutritional status after a pylorus-preserving pancreaticoduodenectomy: comparison between an antecolic and a vertical retrocolic duodenojejunostomy

BackgroundAlthough an antecolic duodenojejunostomy was reported to reduce post-operative delayed gastric emptying (DGE) compared with a retrocolic duodenojejunostomy after a pylorus-preserving pancreaticoduodenectomy (PPPD), the long-term effects of these procedures have rarely been studied. The aim of this prospective, randomized, clinical trial was to investigate the influence of the reconstruction route on post-operative gastric emptying and nutrition. MethodsReconstruction was performed in 116 patients with an antecolic duodenojejunostomy (A group, n = 58) or a vertical retrocolic duodenojejunostomy (VR group, n = 58). Post-operative complications, including DGE, gastric emptying variables assessed by 13C-acetate breath test and nutrition, were compared between the two groups for 1 year post-operatively. ResultsThe incidence of DGE was not significantly different between the procedures (A group: 12.1%; VR group: 20.7%, P = 0.316). At post-operative month 1, gastric emptying was prolonged in the VR versus the A group but not significantly so. At post-operative month 6, gastric emptying was accelerated significantly in the A versus the VR group. Post-operative weight recovery was significantly better in the VR versus the A group at post-operative month 12 (percentage of pre-operative weight, A group: 93.8 ± 1.2%; VR group: 98.5 ± 1.3%, P = 0.015). ConclusionsA vertical retrocolic duodenojejunostomy was an acceptable procedure for the lower incidence of DGE and may contribute to better weight gain affected by moderate gastric emptying.

Efficacy of Laparoscopic Pyloroplasty for the Treatment of Gastroparesis

The modest results of nonoperative modalities for the treatment of gastroparesis necessitate greater consideration of surgical therapies. However, the role of surgery is not well defined. The aim of this study is to present our experience with laparoscopic pyloroplasty as early treatment for gastroparesis. Fifty patients with refractory gastroparesis underwent laparoscopic pyloroplasty (hand-sewn Heineke-Mikulicz configuration) from 2006 to 2013 at our institution. Preoperative and postoperative symptom data, gastric emptying scintigraphy, and technical outcomes of the procedure were reviewed. A single-factor ANOVA was performed for the comparison of continuous variables. Results are reported as mean ± SD or median absolute deviation. Thirty-four of 50 (68%) patients had previous foregut procedures and/or cholecystectomy. Thirty-two of 50 (64%) patients underwent concomitant procedures (ie, paraesophageal hernia repair and gastrostomy takedown) along with the pyloroplasty. Operative time, including combined procedures, blood loss, and length of stay were 175 ± 56 minutes, 64 ± 50 mL, 2.5 ± 2.7 days, respectively. There were no conversions to open technique or intraoperative complications. There were no suture-line leaks. The readmission rate was 14%. All patients had symptom follow-up and 33 (66%) had postoperative gastric emptying scintigraphy. Postoperative symptom improvement was reported by 82% of the patients (p < 0.001). Median preoperative T1/2 was 180 ± 73 minutes and postoperative T1/2 was 60 ± 23 minutes (p < 0.001). Five patients (10%), who had normalized postoperative T1/2 times, required other gastric emptying procedures; distal gastrectomy (n = 2), duodenojejunostomy (n = 2), and gastric stimulator placement (n = 1). Laparoscopic pyloroplasty is an effective early-treatment modality for selected cases of gastroparesis, with substantial improvement in objective gastric emptying times and low morbidity. The laparoscopic approach does not preclude subsequent procedures when necessary.