Proximal Gastric Pouch Research Articles

The bypassed stomach

Retrograde duodenogastroscopy solves the problem of postoperative evaluation of the gastric bypass patient. The stomach may be bypassed to treat morbid obesity, but it no longer need be inaccessible. Endoscopic gastritis is rare in the proximal gastric pouch but common in the distal gastric segment and may be related to the presence of bile. Although the gastric mucosa is histologically normal in half of the gastric bypass patients, acute and chronic gastritis, regenerative changes, and intestinal metaplasia may develop in either or both segments. The causes and implications of these endoscopic and histologic findings are unknown.

Radiographic abnormalities after gastric bypass.

Postoperative radiographic findings in the gastrointestinal tract were analyzed in 43 of 72 patients with gastric bypass for morbid obesity. In 15 patients studied because of early postoperative vomiting or abdominal pain, two showed leak from the proximal gastric pouch and six showed impairment of proximal pouch emptying at the anastomosis or proximal efferent loop. In four of the six, the impaired emptying was due to transient postoperative edema and improved spontaneously. Three patients had impairment of distal gastric pouch emptying due to pylorospasm. Five patients studied in the late postoperative period showed dehiscence of the gastric staple line, which can be difficult to demonstrate radiographically. Familiarity with the normal and the abnormal radiographic appearance after gastric bypass is important in elucidating the nature of the problems that can arise after this operation.

Meal stimulated gastrin and pancreatic polypeptide levels before and after partial gastric transection for morbid obesity.

The aim of the study was to determine the basal and meal stimulated plasma gastrin and pancreatic polypeptide levels in six morbidly obese patients before and after partial gastric transection (gastroplasty), an operation which results in the distention of the stomach with a small volume of food. The partial gastric transection involved the creation of a proximal gastric pouch of approximately 100 ml, with a 1.2 cm diameter lumen between the proximal and distal gastric pouch. Basal gastrin and pancreatic polypeptide were not altered by the operation. The magnitude of the pancreatic polypeptide response to the mean was significantly depressed, although the time course was not changed. Inhibition of pancreatic secretion is thought to be a physiological function of pancreatic polypeptide, hence its decreased release warrants further investigation in relation to the effect of partial gastric transection on pancreatic function.

Gastroplasty in morbid obesity: a progress report.

AbstractThe lower mortality and morbidity rates of the gastric partitioning operations seem to be the primary reason for their increasing popularity among surgeons everywhere. Two hundred patients in our series underwent gastroplasty for morbid obesity. A measured 60‐ml proximal gastric pouch is formed as the TA‐90 is doubly applied across the upper stomach, just distal to the esophagogastric junction. The egress channel is located on the greater curvature, supported by a continued seromuscular inverting layer using 2‐0 polypropylene suture and a second interrupted inverting layer using 4‐0 Dacron® sutures. There were 154 females and 46 males in the series. The mean age was 34.2 years and the mean kg overweight, 67.4. The early postoperative complication rate was 19%, including 1 cardiac death, for a 0.5% mortality rate. Twelve percent revision rate included 15 staple line disruptions, 3 enlarged channels, 4 channel stenoses, and 2 enlarged pouches. Staple line dehiscence continues to be of concern with stapling in continuity. Liquid or pureed diet restriction for the first 12 postoperative weeks decreases the incidence of this complication. The second application of TA‐90 and the preservation of adequate blood supply to the pouch are important factors in the preservation of the integrity of the staple line. Ninety percent of total weight loss occurred at 12 months. Weight loss was maintained at 18 and 24 months.

Can endogenous gastrin inhibit canine interdigestive gastric motility?

Our aim was to determine whether endogenously released gastrin inhibits cyclic interdigestive motility in the proximal stomach. In 4 dogs with chronic duodenal electrodes and isolated innervated antral pouches, we constructed proximal gastric pouches, the external neural connections of which were completely severed by autotransplanting the pouches to the left pelvis. After recovery, the antral pouch was irrigated with 0.2% acetylcholine for 3.7 hr at 90 ml/hr, while intraluminal pressure was monitored in the proximal gastric pouch and myoelectric activity was recorded from the duodenum. Blood was collected concurrently for radioimmunoassay of gastrin. The antral irrigations increased serum gastrin from a mean ± SEM of 85 ± 14 pg/ml before irrigation to a mean ± SEM of 350 ± 54 pg/ml after 30 min of irrigation (P < 0.001), and the increased levels continued throughout the remaining 3.2 hr of irrigation. The irrigations also suppressed the cycles of interdigestive motor activity in the proximal gastric pouch and the cycles of interdigestive myoelectric activity in the duodenum. The cycles had a mean duration ± SEM of 105 ± 5 min before irrigation in both the proximal gastric pouch and duodenum, but were abolished in every test during irrigation. Irrigation inhibited the cycles even when cimetidine was given intravenously at 200 mg/hr to block gastrinstimulated secretion of HCl, duodenal acidification, and subsequent release of duodenal hormones. However, cimetidine alone had no effect on the interdigestive cycles. We concluded that antral irrigation with acetylcholine inhibited interdigestive cyclic motility in the proximal stomach via a hormonal mechanism and that gastrin was likely the hormone involved.

A study of fundoplication disruption and deformity

Three distinct forms of postoperative breakdown after Nissen fundoplication have been discussed. Disruption and recurrent reflux is most common, with slipping occurring infrequently. For the first time, three patients developing a proximal gastric pouch deformity causing partial obstruction of the fundus without recurrent herniation are reported on. Two patients required remedial surgery.