Postgastrectomy and Postvagotomy Syndromes

ISBN-13: 9783642673528 / Angielski / Miękka / 2012 / 188 str.

H. D. Becker; W. F. Caspary

Opis

Besides the mortality rate the value of an operative procedure is measured against the incidence and the degree of undesirable postoperative sequelae. In the surgical treatment of gastroduo denal ulcerations vagotomy is now competing with the success fully established resection therapy. Since this latter method has been further developed during the last years and late results are rare, a comparison between both types of operation is difficult. Meritoriously, the authors have tried to perform a comprehensive analysis. Due to the complexity of postoperative syndromes the diagnostic procedure and treatment can be successful only after integrated cooperation by gastroenterologists and surgeons. This is documented by the current monograph which originates from a cooperation of several years and an active exchange of scientific will facilitate the indica and practical experience. The monograph tion for the primary surgical procedure by critical confrontation of the postoperative syndromes and provide advice in treating postoperative complaints. We hope that the monograph will have the expected impact, which means the spreading of the actual knowledge of post gastrectomy and postvagotomy syndromes."

Spis treści

I Gastric Surgery and its Results.- 1 Short Historical Survey.- 2 Results of Gastric Surgery.- 2.1 Gastric Resection in Peptic Ulcer Disease.- 2.2 Truncal Vagotomy plus Drainage in Duodenal Ulcer Patients.- 2.3 Comparison of Truncal Vagotomy and Gastric Resection.- 2.4 Comparison of Different Drainage Procedures in Vagotomy.- 2.5 Comparison of Truncal Vagotomy and Selective Gastric Vagotomy.- 2.6 Selective Proximal Vagotomy.- 2.7 Comparison of Selective Gastric Vagotomy and Selective Proximal Vagotomy.- 2.8 Summary.- References.- II Diagnostic Procedures.- 3 X-ray Findings.- References.- 4 Postoperative Endoscopy.- 5 Gastric Secretory Analysis.- 5.1 Pentagastrin Test.- 5.1.1 Gastric Secretion after Billroth I and Billroth II Resection.- 5.1.2 Gastric Secretion after Vagotomy.- 5.1.3 Acid Secretion in Zollinger-Ellison Syndrome.- 5.2 Insulin Test.- 6 Endocrine Provocation Tests.- 6.1 Calcium Infusion Test.- 6.2 Secretion Test.- 6.3 Glucagon Test.- References.- 7 Gastric Emptying.- 7.1 Mechanism and Regulation.- 7.2 Isotope Tests.- 7.3 Gastric Emptying after Gastric Surgery.- References.- 8 Measurement of Reflux.- References.- 9 Laboratory Tests for Malabsorption.- 9.1 Absorptive Function Tests.- 9.1.1 Upper Small Intestine.- 9.1.1.1 Oral Glucose Tolerance Test.- 9.1.1.2 d-Xylose Test.- 9.1.1.3 Lactose Tolerance Test.- 9.1.1.4 Faecal Fat Excretion.- 9.1.1.5 Breath Tests.- 9.1.1.6 Small-Bowel Biopsy.- 9.1.2 Ileum.- 9.1.2.1 Schilling Test.- 9.1.2.2 14C-Glycocholate Breath Test.- 9.2 Measurement of Enteric Loss of Protein.- References.- III Postgastrectomy Syndromes.- 10 Dumping.- 10.1 History and Definition.- 10.2 Early Dumping.- 10.2.1 Symptoms.- 10.2.2 Incidence.- 10.2.3 Natural Course.- 10.2.4 Aetiology.- 10.2.5 Medical Treatment.- 10.2.6 Surgical Treatment.- References.- 10.3 Late Dumping.- 10.3.1 Pathogenesis.- 10.3.2 Therapy.- References.- 11 Afferent-Loop Syndrome.- 11.1 Acute ALS.- 11.2 Chronic ALS.- 11.2.1 Therapy.- 11.2.1.1 Braun’s Jejunojejunal Entero-anastomosis.- 11.2.1.2 Roux-en-Y Anastomosis.- 11.2.1.3 Conversion of Billroth II to Billroth I.- 11.2.1.4 Removal of a Simple Gastro-enterostomy.- 11.2.1.5 Jejunoplasty.- References.- 12 Efferent-Loop Syndrome.- References.- 13 Postoperative Reflux Gastritis.- 13.1 Pathogenesis.- 13.1.1 Differentiation from Chronic Afferent-Loop Syndrome.- 13.1.2 Measurement of Bile Reflux.- 13.1.3 Experimental Results.- 13.1.4 Mechanisms Involved in Gastric Mucosal Damage.- 13.1.5 Lysolecithin — a Pathogenetic Factor?.- 13.2 Symptoms and Diagnosis.- 13.3 Medical Treatment.- 13.4 Surgical Treatment.- References.- 14 Postoperative Reflux Oesophagitis.- 14.1 Incidence.- 14.2 Pathogenesis.- 14.3 History and Clinical Symptoms.- 14.4 Therapy.- References.- 15 Gastro-Ileostomy.- References.- 16 Recurrent Peptic Ulceration.- 16.1 Incidence.- 16.2 Aetiology.- 16.2.1 Inadequate Surgery.- 16.2.2 Hypersecretion of Acid.- 16.2.3 Ulcerogenic Agents.- 16.3 Diagnosis.- 16.3.1 Clinical Symptoms.- 16.3.2 Radiological Examination.- 16.3.3 Gastroscopy.- 16.3.4 Gastric Analysis.- 16.4 Conservative Treatment.- 16.5 Surgical Therapy.- 16.6 Therapy of Gastrojejunocolic Fistula.- References.- 17 Gastric Remnant Carcinoma.- 17.1 Definition.- 17.2 Incidence, Risk and Interval After Operation.- 17.3 Pathogenetic Factors.- 17.4 Symptoms.- 17.5 Diagnostic Procedures.- 17.6 Therapy Prognosis.- References.- 18 Postgastrectomy Malabsorption.- 18.1 Incidence of Weight Loss and Steatorrhoea.- 18.2 Physiology of Fat Digestion and Absorption.- 18.3 Pathophysiology of Postgastrectomy Steatorrhoea.- 18.3.1 Gastric Mechanism.- 18.3.2 Pancreaticocibal Asynchrasy.- 18.3.3 Small-intestinal Factors.- 18.3.4 Bacterial Overgrowth.- 18.3.5 Bacteria and Bile Acid Metabolism.- 18.4 Diagnosis.- 18.5 Treatment.- References.- 19 Postgastrectomy Anaemia.- 19.1 Incidence.- 19.2 Iron-Deficiency Anaemia.- 19.3 Vitamin B12 Deficiency.- 19.4 Folate Deficiency.- References.- 20 Postgastrectomy Bone Disease.- 20.1 Incidence.- 20.2 Osteomalacia and Osteoporosis.- 20.3 Metabolic Findings.- 20.4 Diagnosis and Treatment.- References.- 21 Special Aspects of Total Gastrectomy.- References.- IV Postvagotomy Syndromes.- 22 Postvagotomy Dysphagia.- 22.1 Incidence, Symptoms and Aetiology.- 22.2 Experimental Findings.- 22.3 Treatment.- References.- 23 Vagal Denervation Syndrome.- 23.1 Pathophysiology.- 23.2 Treatment.- References.- 24 Postvagotomy Diarrhoea.- 24.1 Definition and Incidence.- 24.2 Aetiology.- 24.3 Therapy.- References.- 25 Cholelithiasis after Vagotomy.- 25.1 Incidence.- 25.2 Pathogenesis.- References.- 26 Recurrent Ulcer after Vagotomy.- 26.1 Incidence.- 26.2 Pathogenetic Factors.- 26.3 Diagnostic Procedure.- 26.4 Treatment.- References.