PURPOSE: The proper reconstruction technique to use after a distal subtotal gastrectomy for a gastric carcinoma, there has been a subject for debated what is the proper reconstruction technique. The aim of this study was to compare the gastric- emptying time and the quality of life following both B-I and B-II reconstructions after a distal gastrectomy for a gastric adenocarcinoma. MATERIALS AND METHODS: We studied 122 patients who had undergone a distal gastrectomy for a gastric adenocarcinoma between June 1999 and July 2002 at our hospital. 51 patients underwent B-I group, and 71 patients underwent B-II group. To evaluate the gastric-emptying time, we analyzed the T1/2 time by means of radionuclide scintigraphy using a gamma camera after ingestion of an (99m)Tc-tin-colloid steamed egg. The nutritional status was measured by the weight change. Postgastrectomy syndrome was evaluated using an abdominal symptoms survey. Dumping syndrome was measured using the Sigstad dumping score. RESULTS: The gastric-emptying time was somewhat delayed in the B-I group after a 6 month period, but there was no difference after 12 months between the two groups. There was less weight loss in the B-I group than in the B-II group (P=0.023). Fewer abdominal symptoms were occurred in the B-I group than in the B-II group. Dumping syndrome occurred less frequently in the B-I group than in the B-II group (P=0.013). CONCLUSION: In our study, the Billroth I reconstruction led to less weight loss, a better nutritional status, and a better quality of life than the Billroth II reconstruction. We concluded that after a distal subtotal gastrectomy, the Billroth I reconstruction would be considered when the procedure is oncologically suitable.
Adenocarcinoma ; Dumping Syndrome ; Eating ; Gamma Cameras ; Gastrectomy ; Gastroenterostomy* ; Humans ; Nutritional Status ; Ovum ; Postgastrectomy Syndromes ; Quality of Life ; Radionuclide Imaging ; Steam ; Stomach Neoplasms ; Weight Loss

To improve postoperative quality of life, and to avoid postgastrectomy syndrome, pylorus-preserving gastrectomy (PPG) is considered as a good option in the middle third early gastric cancer. Convetional PPG has limitation in number 5 lymph node dissection because of preservation of blood supply and nerve innervation to the pylorus. To expand the indication of PPG, limitation on lymph node dissection must be overcomed. In case of laparoscopic PPG, there have been few reports in the literature. Herein we report a case of totally laparoscopic PPG with D2 lymph node dissection with review of literature.
Gastrectomy* ; Laparoscopy ; Lymph Node Excision* ; Lymph Nodes* ; Postgastrectomy Syndromes ; Pylorus ; Quality of Life ; Stomach Neoplasms

Nutrition plays a major role in cancer development and treatment. Malnutrition is a significant and common problem in cancer patients and has been recognized as an important component of adverse outcomes, including increased morbidity and mortality. At the time of diagnosis, the majority of patients with upper gastrointestinal cancer, including those having undergone gastrectomy, have already suffered from significant nutritional deficiencies. Therefore, optimization of nutritional status can help cancer patients maintain the body's nutrition stores and improve symptoms such as anemia and neuropathy that may be associated with nutritional deficiencies. Depending on the etiology of symptoms, iron or Vitamin B12 (injection or oral) may be given. Early recognition and detection of risk for malnutrition may be performed using nutrition screening followed by comprehensive assessments. The most effective approach to malnutrition and nutritional deficiency is the prevention of its initiation through nutrition monitoring and intervention.
Anemia ; Gastrectomy ; Gastrointestinal Neoplasms ; Humans ; Iron ; Malnutrition ; Mass Screening ; Nutritional Status ; Postgastrectomy Syndromes ; Vitamin B 12

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

Surgery is the main curative treatment for gastric cancer. As surgical techniques continue to improve, the scope of radical resection and lymph node dissection has formed consensus and guidelines, so people's attention has gradually shifted to the quality of life (QOL) of patients after surgery. Postgastrectomy syndrome is a series of symptoms and signs caused by complications after gastrectomy, which can affect the quality of life of patients with gastric cancer after surgery. Gastrectomy and anastomosis are closely related to postgastrectomy syndrome. The selection of appropriate surgical methods is very important to the quality of life of patients after surgery. This article reviews the effects of gastrectomy procedures on postoperative quality of life of patients with gastric cancer and its evaluation methods.
Gastrectomy/methods* ; Humans ; Lymph Node Excision/adverse effects* ; Postgastrectomy Syndromes ; Quality of Life ; Stomach Neoplasms/complications*

A Radical gastrectomy can affect the dumping syndrome, reflux gastritis, injury of the autonomic nervous system and the small capacity syndrome and can cause some problems in the quality of life for post-gastrectomy patients. To minimize these complications in the treatment of early gastric cancer (EGC), various gastric-reduced operations have been discussed by gastric surgeons. A pylorus preserving gastrectomy (PPG) is a kind of reduced-gastric operation which preserves the distal portion (1.5 cm) of the gastric antrum and reduces postoperative complications such as the dumping syndrome and reflux esophagitis. However, a limitation of this operation is that complete lymph node dissection of the suprapyloric lymph node is undesirable for preservation of the pyloric branch of the vagus nerve. Nowadays, some reports state that this operation may be applicable in EGC confined to the mucosa and located at the gastric mid-body. (Purpose) This study was designed to evaluate the gastric function after PPG by using solid foods to obtain the gastric emptying time. (Materials and Method) From June 1995 to December 1995, we performed PPGs on 7 patients (4 patients with mucosal cancer, 2 patients with gastric ulcer and 1 patient with a leiomyoma) and Billroth I reconstruction in 7 patients (5 patients with mucosal cancer, 1 patient with advanced gastric cancer and 1 patient with gastric ulcer). To compare the gastric function between these two subgroups, we analyzed the lag time, T1/2 and the residual food after 100 min using 99mTc-tin-colloid-steamed eggs to obtain the gastric emptying time for the PPG group (n=7), the Billroth I reconstruction group (n=7), and the normal control group (n=7). A statistical analysis was done by using the Kruskal-Wallis test (Chi-square approximation). (Results) There were no differences in the amount of transfusion, the hospital stay, the operation time, and the body weight loss after operation between the PPG group and the Billroth I reconstruction group. The severe dumping syndrome and reflux esophagitis were found in one of the patients after Billroth I reconstruction, but were not found in PPG group. Statistically, there was no difference in T1/2 between the Billroth I reconstruction group and the PPG group; however, both lag times were longer than that of the normal control group. We also found that the residual food 100 min after oral intake was greater in both the Billroth I reconstruction and the PPG groups than in the normal control group. (Conclusion) Though both PPG and Billroth I reconstruction showed delayed gastric emptying, we found that PPG is superior to Billroth I reconstruction in lag time and in the amount of residual food after 100 min. We conclude that PPG is superior to Billroth I reconstruction in gastric motility, and if this operation is applied in indicated gastric cancer patients, post-operative complications, such as the dumping syndrome and reflux esophagitis can be reduced and the quality of life in post-gastrectomy patients can be increased.
Autonomic Nervous System ; Body Weight ; Dumping Syndrome ; Eggs ; Esophagitis, Peptic ; Gastrectomy ; Gastric Emptying ; Gastritis ; Gastroenterostomy ; Humans ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Mucous Membrane ; Ovum ; Postgastrectomy Syndromes* ; Postoperative Complications ; Pyloric Antrum ; Pylorus ; Quality of Life ; Stomach Neoplasms ; Stomach Ulcer ; Vagus Nerve

BACKGROUND/AIMS: After gastrectomy, patients often experience various gastrointestinal symptoms due to the rapid emptying of ingested food into the small intestine. Symptoms of the postgastrectomy syndrome, however, decrease as time passes. The aim of this study is to evaluate the role of sensory function of the small intestine in postgastrectomy patients. METHODS: Liquid meal loading test and balloon distension stimuli test were carried out in 39 postgastrectomy patients and 32 healthy controls. The polyethylene balloon was advanced to intestine, 10 cm apart from anastomosis in patients and 3rd portion of duodenum in controls. Sensory function was assessed by scoring perception for nausea, fullness, and abdominal discomfort or pain during random-order stimulus of 20, 40, and 60 ml of balloon inflation. RESULTS: The maximum tolerable volume of liquid meal intake for postgastrectomy patients was significantly less than that of the controls (p<0.05). Twelve of the 26 patients, who ingested less than normal range, had symptoms of the postgastrectomy syndrome. Total sensation scores after balloon distension stimuli were significantly lower than those of the controls. The type of gastrectomy and the postsurgical duration did not affect the maximum tolerable volume of liquid meal and total sensation scores after balloon distension stimuli. CONCLUSIONS: In comparison to healthy controls, postgastrectomy patients showed an obviously lower maximum tolerable volume of liquid meal, in addition to being significantly less perceptive of small intestine to distension stimuli. This decrease of small intestinal perception is deduced to be part of the adaptation to rapid emptying of ingested food into the small intestine in such patients.
Compliance ; Duodenum ; Gastrectomy* ; Humans ; Inflation, Economic ; Intestine, Small ; Intestines ; Meals ; Nausea ; Polyethylene ; Postgastrectomy Syndromes ; Reference Values ; Sensation

PURPOSE: The purpose of this case report is to describe the surgical procedure of pylorus preserving gastrectomy and treatment methods, and the nursing process for postoperative complications namely delayed gastric emptying. METHODS: This case study describes the treatment methods and nursing process for a patient who visited the emergency room because of delayed gastric emptying after a pylorus preserving gastrectomy. RESULTS: The symptoms of this patient were resolved by botox-injection, none per oral, total parenteral nutrition, nutrition education after diagnosis by using abdominal x-ray, gastric emptying study, upper gastrointestinal series, and esophagogastroduodenoscopy. CONCLUSION: According to the result of this case study, nurses should be informed about delayed gastric emptying and how to apply the correct nursing process to the patient.
Diagnosis ; Education ; Emergency Service, Hospital ; Endoscopy, Digestive System ; Gastrectomy* ; Gastric Emptying* ; Humans ; Nursing Process ; Nursing* ; Parenteral Nutrition, Total ; Postgastrectomy Syndromes ; Postoperative Complications ; Pylorus ; Stomach Neoplasms*

PURPOSE: Pylorus-preserving gastrectomy (PPG), which retains pyloric ring and gastric function, has been accepted as a function-preserving procedure for early gastric cancer for the prevention of postgastrectomy syndrome. This study was compared laparoscopy-assisted pylorus-preerving gastrectomy (LAPPG) with laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction (LADGB I). MATERIALS AND METHODS: Between November 2006 and September 2007, 39 patients with early gastric cancer underwent laparoscopy-assisted gastrectomy in the Department of Surgery at Korea Cancer Center Hospital. 9 of these patients underwent LAPPG and 18 underwent LADGBI. When LAPPG was underwent, we preserved the pyloric branch, hepatic branch, and celiac branch of the vagus nerve, the infrapyloric artery, and the right gastric artery and performed D1+beta lymphadenectomy to the exclusion of suprapyloric lymph node dissection. The distal stomach was resected while retaining a 2.5~3.0 cm pyloric cuff and maintaining a 3.0~4.0 cm distal margin for the resection. RESULTS: The mean age for patients who underwent LAPPG and LADGBI were 59.9+/-9.4 year-old and 64.1+/-10.0 year-old, respectively. The sex ratio was 1.3:1.0 (male 5, female 4) in the LAPPG group and 2.6:1.0 (male 13, female 5) in the LADGBI group. Mean total number of dissected lymph nodes (28.3+/-11.9 versus 28.1+/-8.9), operation time (269.0+/-34.4 versus 236.3+/-39.6 minutes), estimated blood loss (191.1+/-85.7 versus 218.3+/-150.6 ml), time to first flatus (3.6+/-0.9 versus 3.5+/-0.8 days), time to start of diet (5.1+/-0.9 versus 5.1+/-1.7 days), and postoperative hospital stay (10.1+/-4.0 versus 9.2+/-3.0 days) were not found significant differences (P>0.05). The postoperative complications were 1 patient with gastric stasis and 1 patient with wound seroma in LAPPG group and 1 patient with left lateral segment infarct of liver in the LADGB I group. CONCLUSION: Patients treated by LAPPG showed a comparable quality of surgical operation compared with those treated by LADGBI. LAPPG has an important role in the surgical management of early gastric cancer in terms of quality of postoperative life. Randomized controlled studies should be undertaken to analyze the optimal survival and long-term outcomes of this operative procedure.
Arteries ; Diet ; Female ; Flatulence ; Gastrectomy ; Gastroparesis ; Humans ; Korea ; Length of Stay ; Liver ; Lymph Node Excision ; Lymph Nodes ; Postgastrectomy Syndromes ; Postoperative Complications ; Seroma ; Sex Ratio ; Stomach ; Stomach Neoplasms ; Vagus Nerve

PURPOSE: Subtotal distal gastrectomy has been accepted as the standard treatment for early gastric cancer that's developed on the gastric body. EMR and ESD have been introduced to minimize the incidence of postgastrectomy syndrome, but these procedures can not detect lymph node metastasis and they have a risk for gastric perforation. Segmental gastrectomy has recently been applied for treating early gastric cancer, but its usefulness has not been clarified. The aim of this study was to compare segmental gastrectomy and distal gastrectomy with Billroth I reconstruction for treating early gastric cancer that's developed on the gastric body. MATERIALS AND METHODS: We performed a retrospective review of all the patients who were diagnosed as having early gastric cancer that developed on the gastric body at Chungnam National University Hospital from January 2004 through July 2007. During this period, 41 patients received segmental gastrectomy and 40 patients underwent subtotal distal gastrectomy. All the patients were studied via a biannual review of the body systems, a physical examination, endoscopy, computed tomography and the laboratory findings. RESULTS: There were no significantly differences of the clinicopathologic characteristics between the two groups. The changes of the nutritional status (Hb, TP, Alb and TC) and the body weight change were not significantly different between the 2 groups. There were significantly more residual food in the SG group than that in the SDG group (RGB classification, Residual>Grade 2), but there were no differences for epigastric discomfort (P>0.05). Esophagitis developed at a similar rate for both two groups (LA classification, >Grade A), and bile reflux was found in only one patient of each group. CONCLUSION: We expected the reduction of esophagitis and gastritis and the improvement of nutritional status according to the type of procedure. Yet the results of our study showed no significant differences between the two study groups. More patients and a longer follow up time are needed for determining the advantage sand disadvantages of segmental gastrectomy.
Bile Reflux ; Body Weight Changes ; Endoscopy ; Esophagitis ; Gastrectomy ; Gastritis ; Gastroenterostomy ; Humans ; Imidazoles ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Nitro Compounds ; Nutritional Status ; Physical Examination ; Postgastrectomy Syndromes ; Retrospective Studies ; Silicon Dioxide ; Stomach Neoplasms