No abstract available.
Duodenal Ulcer* ; Vagotomy, Truncal*

BACKGROUND: To date, a laparoscopic gastrectomy has been performed by a small number of surgeons around the world, but the laparoscopic approach has been extended to Billroth I and a total gastrectomy. To evaluate the validity of the procedure, we present the results of six patients who underwent a gastrectomy using a laparoscopic technique. METHODS: First, two patients had a totally intra-abdominal laparoscopic B-II gastrectomy, and one of two also had a bilateral truncal vagotomy. The rest had a laparoscopic-assisted gastrectomy. One patient had concurrently an open reduction and an internal fixation with a K-wire for a patellar fracture. Indications were (a) gastric outlet obstruction due to peptic ulcer disease in five patients and (b) duodenal ulcer bleeding in one patient. RESULTS: Except for one patient who had stump leakage, which was solved by conservative therapy, there were no complications or operative mortality. The operating time and the cost were less for the patients who had their operations later in the series and who had laparoscopic-assisted operation. CONCLUSIONS: These forms of laparoscopic gastric surgery for patients with complications of peptic ulcer disease may be useful from the standpoint of minimal access, rapid recovery, less pain, and good cosmesis.
Duodenal Ulcer ; Gastrectomy* ; Gastric Outlet Obstruction ; Gastroenterostomy ; Hemorrhage ; Humans ; Mortality ; Peptic Ulcer ; Stomach Diseases* ; Vagotomy, Truncal

Gastric peptic ulcer operation is designed to reduce gastric secretion, of gastric acid and pepsin enough to control the peptic ulcer diathesis and also to have least complications after operation which are related to alterations of gastric motility and emptying rate. The author studied the physiologic effects of proximal gastric vagotomy with pyloroplasty on the gastric secretion, gastric acid, gastric pepsin, gastric motility and gastric emptying rate by means of the ballon-physiographic method through gastric fistula. In this exprimental studies, 2 kinds of animal i.e. dogs and cats were used. 15 dogs were used which were divided into 5 groups i.e. gastrostomy for control, proximal gastric vagotomy, truncal vagotomy only and truncal vagotomy with gastric pyloroplasty. Cats were used 25 ones which were divided into 3 groups i.e. gastrostomy for control, proximal gastric vagotomy and truncal vagotomy and following results and conclusion were obtained. 1. Important role on the gastric secretion, gastric acid, gastric pepsin, gastric motility, gastric emptying and the relationship between the intragastric pressure and volume.2. Both proximal gastric vagotomy and subtotal gastrectomy(Billroth II) made a marked reduction on the gastric secretion, gastric acid and gastric pepsin than that of control group but were similar to control group on the gastric motility and gastric emptying rate. 3. Truncal vagotomy alone caused marked reduction on gastric secretion, gastric acid and gastric pepsin and showed remarkable slowness on gastric motility and gastric emptying rate. 4. The wave of contraction and motility index in duodenum were more higher than that gastric body and antrum and antral contraction is higher than that of gastric body in control groups. 5. Pacesetter potential is formed by intrinsic myogenic phenomena and is related to motor activity and gastric emptying. 6. Truncal vagotomy with pyloroplasty hastened the gastric emptying rate of liquid meals and rate of emptying of solid meals was slightly faster than that of control groups. 7. Emptying of liquid meal is controlled by intragastric transmural pressure and emptying of solid meal is controlled by antral contraction. 8. The vagus distributed on the stomach was divided into cholinergic excitory fibers and noncholinergic or nonadrenergic inhibitory fibers. As gastric vagal inhibitory fibers were cut when vagotomy was done, pyloroplasty was must be done.
Animals ; Cats ; Disease Susceptibility ; Dogs ; Duodenum ; Gastric Acid ; Gastric Emptying ; Gastric Fistula ; Gastrostomy ; Meals ; Motor Activity ; Pepsin A ; Peptic Ulcer* ; Stomach ; Vagotomy ; Vagotomy, Proximal Gastric ; Vagotomy, Truncal

BACKGROUND : Truncal vagotomy produces a reduction in bile flow, an increased gallbladder volume, a delay in gallbladdr emptying, decrease in resting pressure, and decreased contraction following stimulation with cholecystokinin. Retrospective studies have suggested that vagotomy can be responsible for a 4 to 6 fold increase in the 4% to 5% control rate of cholelithiasis noted in the Framingham study. The measurement of the gallbladder ejection fraction by using Tc-99m DISIDA scintigraphy is suitable for the study of the motor functions of the gallbaldder. A gallbladder ejection fraction of less than 35% is highly predictive of the presence of gallbladder disease and is a good indicator of a favorable outcome following a cholecystectomy. METHODS : Between January 1995 and December 1996, 24 patients (truncal vagotomy + pyloroplasty, 5; truncal vagotomy partial + gastrectomy + Billroth I, 4; truncal vagotomy + partial gastrectomy + Billroth II, 12; total gastrectomy, 3) and 18 healthy volunteers were investigated prospectively by Tc-99m DISIDA scintigraphy for the measurement of the gallbladder ejection fraction. RESULTS : In normal subjects, the mean value of the gallbladder ejection fraction was 70.8%, and in patients after a gastric operations, it was 66.0% (p>0.05). Three (25.0%) of the 12 patients with a truncal vagotomy, partial gastrectomy, and Billroth II gastrojejunostomy had gallbladder ejection fractions of less than 35% (p<0.05). CONCLUSIONS : There was no difference in the gallbladder ejection fractions between the control group and the patients after gastric operations, including a truncal vagotomy. However there was a significant difference between the patients with a truncal vagotomy, partial gastrectomy, and Billroth II anastomosis and those receiving other gastric operations.
Bile ; Cholecystectomy ; Cholecystokinin ; Cholelithiasis ; Gallbladder Diseases ; Gallbladder* ; Gallstones ; Gastrectomy ; Gastric Bypass ; Gastroenterostomy ; Healthy Volunteers ; Humans ; Prospective Studies ; Radionuclide Imaging* ; Vagotomy ; Vagotomy, Truncal

Gastrojejunocolic fistula is a rare condition after gastrojejunostomy. It is severe complications of gastrojejunostomy, which results an inadequate resection or incomplete vagotomy during peptic ulcer surgery. The symptoms are diarrhea, upper abdominal pain, bleeding, vomiting and weight loss. A 55-year-old man with chronic diarrhea and weight loss for 6 months visited Dankook University Hospital. The patient had received a truncal vagotomy and gastrojejunostomy for duodenal ulcer obstruction 15 years previously. The patient underwent gastroscopy and upper gastrointestinal series evaluations, which detected the gastrojejunocolic fistula. After improving of malnutrition, an exploratory laparotomy was undertaken, which revealed that the gastrojejunostomy site and the T-colon formed adhesion and fistula. En block resection of the distal stomach and T-colon included the gastrojejunocolic fistula, and Roux-en-Y gastrojejunostomy was performed. Recovery was uneventful and the patient remained well at the follow-up. We report a gastrojejunocolic fistula, which is a rare case after gastrojejunostomy.
Abdominal Pain ; Diarrhea ; Duodenal Ulcer ; Fistula ; Follow-Up Studies ; Gastric Bypass ; Gastroscopy ; Hemorrhage ; Humans ; Laparotomy ; Malnutrition ; Peptic Ulcer ; Stomach ; Vagotomy ; Vagotomy, Truncal ; Vomiting ; Weight Loss

BACKGROUNDS:Bile reflux gastritis can occur when pylorus ablation is associated with bile stasis in the stomach. It can also occur with a gastrojejunostomy when bile is continuously poured into the gastric remnant after a vagotomy and an antrectomy. The diagnosis of bile reflux gastritis can be made only when the patient has bile gastritis documented on biopsy; the simple observation of a bile-stained mucosa in a gastric remnant is not sufficient to make the diagnosis of bile reflux gastritis. METHODS: Technetium-99m diisopropyl iminodiacetic acid (Tc-99m DISIDA) scintigraphy was used to study bile reflux into the gastric remnant in 31 patients with gastric operations. All patients had gastrofibroscopic biopsies in order to identify the bile reflux gastritis. RESULTS: Tc-99m DISIDA Scintigraphy identified bile reflux in 15 (83.2%) of 18 patients after a subtotal gastrectomy and a Billroth II gastrojejunostomy. Hewever, no bile reflux occured in either the 10 patients with a hemigastrectomy plus Billroth I gastoduodenostomy or the 3 patients with a truncal vagotomy plus pyloroplasty. Also, gastrofibroscopic biopsies identified bile reflux gastritis in only 3 patients (9.7%) with a subtotal gastrectomy plus Billroth II reconstruction. CONCLUSIONS: The patients who underwent a subtotal gastrectomy and Billroth II reconstruction showed higher bile reflux rates than did the patients who underwent a hemigastrectomy plus Billroth I reconstruction and a truncal vagotomy plus pyloroplasty (p<0.05). Also, only 9.7% of the postgastrectomy patients developed bile reflux gastritis.
Bile Reflux ; Bile* ; Biopsy ; Diagnosis ; Gastrectomy ; Gastric Bypass ; Gastric Stump ; Gastritis ; Gastroenterostomy ; Humans ; Mucous Membrane ; Pylorus ; Radionuclide Imaging* ; Reflex* ; Stomach ; Vagotomy ; Vagotomy, Truncal

PURPOSE: Peptic ulcer disease (PUD) remains one of the most prevalent gastrointestinal diseases and an important target for surgical treatment. Laparoscopy applies to most surgical procedures; however its use in elective peptic ulcer surgery, particularly in cases of pyloric stenosis, has not been popular. The aim of this study was to describe the role of laparoscopic surgery and an easily performed procedure for pyloric stenosis. We accordingly performed laparoscopic truncal vagotomy with gastrojejunostomy in 10 consecutive patients with pyloric stenosis. METHODS: Data were collected prospectively from all patients who underwent laparoscopic truncal vagotomy with gastrojejunostomy from August 2009 to May 2014 and reviewed retrospectively. RESULTS: A total of 10 patients underwent laparoscopic trucal vagotomy with gastrojejunostomy for peptic ulcer obstruction from August 2009 to May 2014 in oo university hospital. The mean age was 62.6 (+/-16.4) years old and mean BMI was 19.3 (+/-2.5) kg/m2. There were no conversions to open surgery and no occurrence of intra-operative complications. The mean operation time was 107 (90~130) minutes and blood loss was < 20 ml. Oral feeding was permitted for most patients on day 3 post operatively after upper gastrointestinal series to confirm no leakage or passage disturbance. The mean hospital stay was 7.3 days, the mean follow up duration was 19.8 (+/-17.2) months, and there was no mortality related to the operation. CONCLUSION: Laparoscopic truncal vagotomy and gastrojejunostomy was a good, easily performed surgical choice for patients with duodenal ulcer stricture.
Constriction, Pathologic ; Duodenal Ulcer ; Follow-Up Studies ; Gastric Bypass ; Gastroenterostomy ; Gastrointestinal Diseases ; Humans ; Laparoscopy ; Length of Stay ; Mortality ; Peptic Ulcer ; Prospective Studies ; Pyloric Stenosis* ; Retrospective Studies ; Vagotomy ; Vagotomy, Truncal*

PURPOSE: An increased incidence of cholelithiasis has been widely reported following a truncal vagotomy and gastrectomy in benign peptic ulcer disease. However, there have been few studies on cholelithiasis following a gastrectomy in gastric cancer patients. Therefore, the incidence, influencing factors, natural course and whether a prophylactic cholecystectomy is required during a gastrectomy were investigated. METHODS: 1, 057 patients with gastric cancer, who received a gastrectomy at Chung-Ang University Hospital between January, 1992 and December, 2001, were reviewed. Of the 1, 057 patients, 591 were included in this study, with 420 and 46 patients excluded due to lack of follow-up after the gastrectomy and because they received a preoperative or concomitant cholecystectomy, respectively. Age, gender, extents of gastrectomy, anastomosis methods and cancer staging were investigated as factors for potential correlation with any incidence. Furthermore, the interval between the gastrectomy and the discovery of cholelithiasis and the number of patients receiving a cholecystectomy due to cholecystitis during the follow-up period were also studied. RESULTS: The preoperative prevalence of cholelithiasis was 7.22% (46/637). The incidence of cholelithiasis after a gastrectomy was 7.61% (45/591), with a mean duration of 32.13+/-28.18 months. There were no significant differences in the incidences of cholelithiasis according to age, gender, extents of gastrectomy or stage (P>0.05). 23 cases of cholelithiasis (50%) were detected within 24 months and 80% (36/45) of all cases developed within 48 months. Among the 45 gallstone patients, only 6 (13.33%) developed acute cholecy- stitis and received a cholecystectomy. CONCLUSION: The incidence of cholelithiasis after a gastrectomy was very low, and was independent of age, gender, and other influencing factors in our study. Therefore, close observation and follow-up evaluation would be helpful in the prevention and detection of cholelithiasis. Also further study will be needed on the relationship between the methods of anastomosis and the incidence of cholelithiasis. The clinical benefits of a prophylactic cholecystectomy during a gastrectomy should also be studied carefully.
Cholecystectomy ; Cholecystitis ; Cholelithiasis* ; Follow-Up Studies ; Gallstones ; Gastrectomy ; Humans ; Incidence ; Neoplasm Staging ; Peptic Ulcer ; Prevalence ; Stomach Neoplasms* ; Vagotomy, Truncal

PURPOSE: To evaluate the incidence,. degree, and clinical significance of non-obstructive intrahepatic bile duct di'latation encountered on follow up CT after gastrectomy for gastric carcinoma. MATERIALS AND METHODS: We retrospectively analyzed follow-up abdominal CT of 65 patients who had undergone gastrectomy with truncal vagotomy and subtotal gastrectomy for gastric carcinoma. We classified those patients who showed intrahepatic duct dilatation into non-obstructive or obstructive groups depending on the presence or absence of the lesions obstructing the duct. We also evaluated the incidence, degree and pattern, and appearance time of non-obstructive type of duct dilatation. RESULTS: Non-obstructive and obstructive biliary dilatations were present in 8 cases(12.3%) and 9 cases(13. 8%), respectively. The degree of non-obstructive group was mild in 6 cases(75%) and moderate in 2 cases (25%) who had taken cholecystectomy during the follow up period, and patterns were proportional dilatation of the central and peripheral intrahepatic ducts. It appeared on follow up CT obtained 6 to 12 months after operation in 7 cases and 3.5 months in one case. No statistical significance was noted between the type of surgery and the incidence of non-obstructive dilatation(p>0.05). CONCLUSION: Mild dilatation of the central intrahepatic ducts without evidence of mechanical biliary obstruction can be seen on follow-up CT obtained more than 6 months after gastrectomy for gastric carcinoma, and the incidence is about 12%. We think that this finding is non-obstructive and clinical evaluation is unnecessary.
Bile Ducts, Intrahepatic ; Cholecystectomy ; Dilatation* ; Follow-Up Studies ; Gastrectomy* ; Humans ; Incidence ; Retrospective Studies ; Tomography, X-Ray Computed ; Vagotomy, Truncal

AIMTo study the possibility that responses of fever and discharge of neurons in PVN to intraperitoneal administration of LPS are mediated by vagal afferents.

METHODSRectal temperature of rat was detected by digital temperature detecting instrument. Glass micropipette placed in PVN was used to record unit discharges of neurons in it, before and after LPS was injected into PVN in normal rats and vagotomy rats.

RESULTSThe rectal temperature change value in vagotomy LPS group was significantly decreased compared with that in sham LPS group, and there was striking difference between them (P < 0.05). The discharges of neurons in PVN was increased in the normal rat in response to LPS. The discharges of neurons in PVN had no significant change in the vagotomy rats in response to LPS.

CONCLUSIONThe results indicate that vagus nerve may be one of the pathways of peripheral LPS signal communicating to CNS.

Animals ; Diaphragm ; innervation ; Fever ; chemically induced ; physiopathology ; Lipopolysaccharides ; Male ; Neurons ; physiology ; Paraventricular Hypothalamic Nucleus ; physiopathology ; Rats ; Rats, Wistar ; Vagotomy, Truncal