The ways to improve the results of the pylorus-preserving gastric resection

Objective. To enhance the results efficacy of the pylorus-preserving gastric resection. Materials and methods. Retrospective estimation of results of the pylorus-preserving gastric resection was conducted while various operative procedures application in 64 patients, ageing 34-75 yrs old. The average age of the patients was (52.5 ± 6.2) yrs old. Results. The patients were divided into two Groups. In Group I (n = 36) the pylorus-preserving gastric resection was performed in accordance to conventional procedure - without identification of infrapyloric arteries and veins as well as vagal branches, innervating pyloric sphincter. In Group II (n = 28) accurate dissection was performed, using special optic technique for preservation of all vascular structures, going to pylorus. Conclusion. The pylorus-preserving gastric resection owes several advantages, because it prevents the postgastrectomy syndrome development.

Some improvements in the technique of creating an "artificial stomach" from the small intestine in partial and total resections of the stomach

The literature of recent decades about the long-term consequences of partial and total resections of the stomach clearly indicates that a significant part of patients after these operations have persistent digestive disorders. The developing peculiar complex symptom complex is designated by various names: "agastral asthenia" (A. A. Busalov, M. S. Govorova), "resection disease" (G. G. Karavanov and O. V. Filts), "hyperglycemic syndrome" (OL Gordon), "hypoglycemic syndrome"; in foreign literature, the term "dumping syndrome" or "postgastrectomy syndrome" is often used.

Reconstructive stage of surgery after cardiectomy

There is no consensus regarding the operation of choice for pathological changes in the proximal stomach, distal esophagus and the area of the cardio-esophageal junction to the present day. In addition to malignancy and peptic ulcer disease, a refractory course of gastroesophageal reflux disease (GERD) and the absence of any effect from primary antireflux surgery may be an indication for performing cardiectomy with reconstruction. To make a choice of the surgical treatment for pathologies of the distal esophagus and proximal stomach method, it is necessary to compare the efficiency and safety profiles of these techniques in many parameters. The main indicators of the effectiveness of reconstructive operations after cardiectomy, are the frequency and severity of a large group of functional disorders characterized as “dumping syndrome” or “postgastrectomy syndrome”. A huge number of different types of anastomosis after cardiectomy has been proposed and studied. Nevertheless, an an objective evaluation of the results of these anastomosis types’ use, indicates that the hopes placed on them did not come true in most cases. It indicates insufficient coverage of this problem in scientific literature, despite the continuing interest of surgeons.

Comparison of Postoperative Quality of Life among Three Different Reconstruction Methods After Proximal Gastrectomy: Insights From the PGSAS Study

Background Proximal gastrectomy (PG) has become an increasingly preferred procedure for early cancer in the upper third of the stomach, owing to reportedly superior quality of life (QOL) after PG when compared with total gastrectomy. However, various methods of reconstruction have currently been proposed. We compared the postoperative QOL among the three different reconstruction methods after PG using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) questionnaire. Methods Post Gastrectomy Syndrome Assessment Study (PGSAS), a nationwide multi-institutional survey, was conducted to evaluate QOL using the PGSAS-45 among various types of gastrectomy. Of the 2,368 eligible data from the PGSAS survey, data from 193 patients who underwent PG were retrieved and used in the current study. The PGSAS-45 consists of 45 items including 22 original gastrectomy specific items in addition to the SF-8 and GSRS. These were consolidated into 19 main outcome measures pertaining postgastrectomy symptoms, amount of food ingested, quality of ingestion, work, and level of satisfaction for daily work, and the three reconstruction methods (n = 193; 115 esophago-gastrostomy [PGEG], 34 jejunal interposition [PGJI], and 44 jejunal pouch interposition [PGJPI]) were compared using PGSAS-45. Results Size of the remnant stomach was significantly larger in PGEG, and significantly smaller in PGJI and PGJPI (P < 0.05). There was no difference in other patient background factors among the groups. EGJPI tended to be superior to PGEG in several of the 19 main outcome with marginal significance (P = 0.047–0.076). Conclusion PGJPI appears to be the most favorable of the three reconstruction methods after PG especially when the size of remnant stomach is rather small. Trial registration number UMIN-CTR #000002116 entitled as “A study to observe correlation between resection and reconstruction procedures employed for gastric neoplasms and development of postgastrectomy syndrome”

About the influence of the way of restoration of the gastrointestinal continuity on function of the pancreas

The analysis of results of surgical treatment of 62 patients with postgastrectomy syndrome: 41 (66.1%) men and 21 (33.9%) women aged from 35 to 69 years (middle age 48.2±13.1 years) has been presented. The signs of chronic pancreatitis have been revealed in 24 (38.7%) patients. Relapsing form was observed in 19 (79.2%) patients, painful – in 5 (20.8%) cases. Performance of the reconstructive operations, providing restoration of natural passage of food through duodenal gut, promoted restoration of indicators of the content of carbohydrates in blood, eliminating the basis of a variety of postgastrectomy damages, including chronic pancreatitis in 6 (25%) patients.