No abstract available.
Gastric Stump*

No abstract available.
Gastric Stump*

Many studies have shown that gastric stump cancer develops after distal gastrectomy, particularly after Billroth II reconstruction. But, recurrent cancer at the duodenal stump following Billroth II type distal gastrectomy for gastric cancer is extremely rare. We report a case of duodenal stump cancer in a 64-year-old man underwent Billroth II distal gastrectomy.
Gastrectomy ; Gastric Stump ; Gastroenterostomy ; Humans ; Middle Aged ; Recurrence ; Stomach Neoplasms

Gastric stump cancer is defined as cancers that develop in the gastric remnant after the gastric resection of nonmalignant lesions or malignant lesions. The interval between gastrectomy and the detection of gastric stump cancer must be over 5 years in nonmaligant lesions and 10 years in malignant lesions. Symptoms of gastric stump cancer are not specific, so, diagnosis is often delayed. Early detection and curative operation is very important in gasric stump cancer and follow-up endoscopic examination is the most importaint diagnostic tool to detect gastric stump cancer. Recently we experienced a case of early gastric stump cancer. We report review of the literature to remind the important of gastric stump cancer and the important of follow-up endoscopic examination.
Diagnosis ; Esophagus* ; Follow-Up Studies ; Gastrectomy* ; Gastric Stump* ; Intestines* ; Stomach*

In Korea, proximal gastrectomy has recently attracted attention as a better choice of function-preserving surgery for proximal early gastric cancer than total gastrectomy. Of the various strategies to overcome reflux symptoms from remnant stomach, double tract reconstruction not only reduces the incidence of anastomosis-related complications, but is also sufficiently reproducible as a laparoscopic procedure. Catching up with the recent rise of single-port laparoscopic surgeries, we performed a pure single-port laparoscopic proximal gastrectomy with DTR. This procedure was designed by merging the function-preserving concept of proximal gastrectomy with single-port laparoscopic total gastrectomy.
Gastrectomy* ; Gastric Stump ; Incidence ; Korea ; Laparoscopy ; Stomach Neoplasms*

Cancer of the gastric stump, first described by Balfour in 1922, is defined as the cancer detected more than 5 years after surgery for a benign disease. We experienced a case of cancer found at the gastric stump after gastrojejunostomy in a 53 years old male patients, proven pathologically as a early cancer. He visited to our hospital with the chief complaint of epigastric pain and indigestion for 1 Months. On past history, he has been received gastrojejunostomy due to duodenal ulcer obstruction, 23 years ago, Gastrofiberscopy was done, and we could find the early gastric cancer lesions at the anterior wall of gastric angle as type Ilc+III and antrum as type IIa. The microscopic finding of the multiple endoscopic biopsies at the gastic angle and antrum revealed the adenocarcinoma of signet ring cell type infiltrated to the level of submucosa. And so, we could diagnose these lesions as a early gastric cancer in the gastric stump after gastrojejunostomy. He was treated with subtotal gastrectomy and discharged with cured condition. Therefore, we report this case with a literature review.
Adenocarcinoma ; Biopsy ; Duodenal Ulcer* ; Dyspepsia ; Gastrectomy ; Gastric Bypass* ; Gastric Stump* ; Humans ; Male ; Middle Aged ; Stomach Neoplasms

Obesity is one of the most significant causes of GERD. Nissen fundoplication is a surgical procedure that's performed world widely for treating patients with GERD and a hiatal hernia and who are intractable to medical therapy. However, Nissen fundoplication may have technical difficulties in morbidly obese patients due to the huge perigastric, intraabdominal fat tissue and hepatomegaly. During the laparoscopic Roux-en-Y Gastric Bypass (LRYGB) procedure, the stomach was divided into the gastric pouch and the remnant stomach by vertiacally stapling at the angle of His. The posterior gastric wall and hiatus were easily exposed even when there was huge deposits of perigatric and intraabdominal fat tissue. We report here on a case of concomitant hiatal hernia repair with LRYGB in a morbidly obese patient.
Fundoplication ; Gastric Bypass ; Gastric Stump ; Gastroesophageal Reflux ; Hepatomegaly ; Hernia, Hiatal ; Humans ; Obesity ; Obesity, Morbid ; Stomach

PURPOSE: An uncut Roux-en-Y gastrojejunostomy has been known to be effective in preventing bile reflux gastritis in the remnant stomach and the Roux stasis syndrome. MATERIALS AND METHODS: To evaluate the usefulness of a totally laparoscopic uncut Roux-en-Y gastrojejunostomy (TLuRYGJ) after a distal gastrectomy, we reviewed the medical records of 19 consecutive patients that underwent a TLuRYGJ at our institution, and 11 consecutive patients who underwent a totally laparoscopic Billroth I gastrectomy (TLB-I) during the same period. RESULTS: Postoperative gastrointestinal symptoms related to the postgastrectomy syndrome and the Visick classification at six months after surgery were not different in the two groups; however, there was no case of symptomatic bile reflux gastritis and only one case of delayed gastric empting, for which medication was required, in the TLuRYGJ group. The endoscopic findings of the remnant stomach for bile reflux gastritis at six months after surgery were better in the TLuRYGJ group than in the TLB-I group. CONCLUSION: A TLuRYGJ was found to be effective in preventing bile reflux gastritis and the Roux stasis syndrome.
Bile Reflux ; Classification ; Gastrectomy* ; Gastric Bypass* ; Gastric Stump ; Gastritis ; Gastroenterostomy* ; Humans ; Laparoscopy ; Medical Records ; Postgastrectomy Syndromes

PURPOSE: Total gastrectomy is followed by weight loss in the majority of patients, but the reason for this is not clear. Ghrelin, a novely isolated gastric hormone, exerts orexigenic activity. If a circulating ghrelin participates in the adaptive response to weight loss, the weight loss induced by total gastrectomy may be accompanied by impaired ghrelin secretion. METHODS: The blood was collected from gastric cancer patients who have undergone gastric resection, preoperatively and immediately after resection, on the 1st, 3rd and 7th postoperative day. The correlation of the preoperative plasma ghrelin concentration with gender, age and BMI were analyzed. The concentration changes of plasma ghrelin were observed serially after dividing gastrectomized patients into the subtotal gastrectomy group, the total gastrectomy group, and the proximal gastrectomy group. RESULTS: Although statistically not significant, the plasma ghrelin concentration was negatively correlated with age and BMI. In the subtotal gastrectomy group, nadir ghrelin was 48.4 +/- 23.6% of the preoperative value after gastric resection and then gradually increased to 82.4 +/- 19.9% on the 7th postoperative day. In the total gastrectomy group, nadir ghrelin was 36.9 +/- 10.4% of the preoperative value after gastric resection and remained 20.9 +/- 10.9% on the 7th postoperative day. In the proximal gastrectomy group, nadir ghrelin was 29.4 +/- 4.6% after gastric resection, which was followed by a gradual recovery. However, the recovery rate was steadier than compare to the subtotal gastrectomy group, as the concentration was 41.8 +/- 23.1% even on 7th postoperative day. CONCLUSION: The principal site of the ghrelin synthesis is stomach which contributes 60~70% to the circulating concentration of ghrelin. In the case of subtotal gastrectomy, ghrelin production is compensated by the remnant stomach. For this reason total gastrectomy is associated with suppressed ghrelin levels and it possibly contribute to the weight loss.
Gastrectomy ; Gastric Stump ; Ghrelin* ; Humans ; Plasma* ; Stomach ; Stomach Neoplasms ; Weight Loss

PURPOSE: Although Roux-en-Y (R-Y) reconstruction after distal gastrectomy has several advantages, such as prevention of bile reflux into the remnant stomach, it is rarely used because of the technical difficulty. This prospective randomized clinical trial aimed to show the efficacy of a novel method of R-Y reconstruction involving the use of 2 circular staplers by comparing this novel method to Billroth-I (B-I) reconstruction. MATERIALS AND METHODS: A total of 118 patients were randomly allocated into the R-Y (59 patients) and B-I reconstruction (59 patients) groups. R-Y anastomosis was performed using two circular staplers and no hand sewing. The primary end-point of this clinical trial was the reflux of bile into the remnant stomach evaluated using endoscopic and histological findings at 6 months after surgery. RESULTS: No significant differences in clinicopathological findings were observed between the 2 groups. Although anastomosis time was significantly longer for the patients of the R-Y group (P<0.001), no difference was detected between the 2 groups in terms of the total surgery duration (P=0.112). Endoscopic findings showed a significant reduction of bile reflux in the remnant stomach in the R-Y group (P<0.001), and the histological findings showed that reflux gastritis was more significant in the B-I group than in the R-Y group (P=0.026). CONCLUSIONS: The results of this randomized controlled clinical trial showed that compared with B-I reconstruction, R-Y reconstruction using circular staplers is a safe and feasible procedure. This clinical trial study was registered at www.ClinicalTrials.gov (registration No. NCT01142271).
Bile ; Bile Reflux ; Gastrectomy* ; Gastric Stump ; Gastritis ; Hand ; Humans ; Methods ; Prospective Studies ; Stomach Neoplasms*