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*

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

PURPOSE: The POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) score was developed to predict post-operative mortality and morbidity rates. The aim of this study was to validate the POSSUM physiologic score (POSSUM-P) in emergent operations for peptic ulcer complications. METHODS: We retrospectively collected data on patients who underwent emergent operation for peptic ulcer complications at Boramae Hospital between January 2003 and April 2009. The data included patients' characteristics (underlying disease, medication, duration of symptoms), operative characteristics (operation method, morbidity, and mortality) and the items for the POSSUM-P (basic information (age, sex, etc.), circulatory and respiratory signs, electrocardiogram, blood pressure, hemoglobin, white blood cell count, potassium level, sodium level, urea level and Glasgow coma scale). The POSSUM-P was calculated and compared according to the morbidity and mortality. RESULTS: One hundred and twelve patients were included. As for operation methods, primary repair (48.2%) was most common, followed by truncal vagotomy with pyloroplasty (27.7%). Thirty-seven patients had morbidities including wound infections (20), pneumonias (14), fluid collections (9), and so on. Eight patients died due to sepsis or pulmonary edema. The means of POSSUM-P were significantly different between patients with and without mortality (37.8 vs. 19.2, P<0.001) and between patients with and without morbidity (26.7 vs. 17.3, P<0.001). Those were different between patients with and without postoperative pneumonia and wound infection (P=0.002 and P=0.029, respectively). CONCLUSION: The POSSUM physiologic score could help to predict the mortality or morbidity after emergency operation for complications of peptic ulcer disease, especially postoperative pneumonia or wound infection.
Blood Pressure ; Coma ; Electrocardiography ; Emergencies ; Hemoglobins ; Humans ; Leukocyte Count ; Peptic Ulcer ; Pneumonia ; Potassium ; Pulmonary Edema ; Retrospective Studies ; Sepsis ; Sodium ; Urea ; Vagotomy, Truncal ; Wound Infection

PURPOSE: Bezoars are the uncommon result of ingestion of poorly digestible or indigestible substances. It is defined as retained concretions of animal or vegetable material in the gastrointestinal tract. The aim of this study was to review and analyze in these cases with reviewing literature. METHODS: The medical records of 12 cases, treated between May 1999 and April 2009, were reviewed. The clinical characteristics, as well as the diagnostic evaluations and results of medical and surgical treatment, were also analyzed retrospectively. RESULTS: Of the 12 cases, 6 men and 6 women, the bezoars were in the stomach, jejunum and ileum or in both stomach and jejunum in 1, 2, 7 and 2 cases, respectively. 4 patients (33.3%) had a history of gastric or duodenal ulcer following previously received gastric surgery such as subtotal gastrectomy or truncal vagotomy with pyloroplasty. In 3 cases, the bezoars were found in operative field under the impression of intestinal obstruction due to adhesive ileus, which could not be found by preoperative radiologic evaluation. Among the 12 cases, 11 cases were successfully treated by operative and endoscopic removal, but 1 case expired due to sepsis. CONCLUSION: A bezoar occurs mainly in patients who have previously undergone a gastric operation. Surgeons should keep in mind the possibility of bezoars in patients presenting an intestinal obstruction following a past gastric operation. The principle of treatment for bezoars used to be surgery, but recently gastric bezoars are often treated by gastrofiberscopy.
Abdomen, Acute ; Adhesives ; Animals ; Bezoars ; Duodenal Ulcer ; Eating ; Female ; Gastrectomy ; Gastrointestinal Tract ; Humans ; Ileum ; Ileus ; Intestinal Obstruction ; Jejunum ; Male ; Medical Records ; Retrospective Studies ; Sepsis ; Stomach ; Vagotomy, Truncal ; Vegetables

PURPOSE: Bezoars are defined as retained concretions of animal or vegetable material in the gastrointestinal tract, and can be classified as trichobezoar, phytobezoar, trichophytobezoar or concretion. The purpose of this study was to review and analyze 25 cases of bezoar. METHODS: The medical records of 25 patients, treated between February 1995 and November 2004, were reviewed. The clinical characteristics, as well as the diagnostic evaluations and results of surgical treatment, were also analyzed retrospectively. RESULTS: Of the 25 patients, 13 men and 12 women, the bezoars were in the stomach, ileum or in both the stomach and ileum in 17, 5 and 2 cases, respectively, with 1 case in the esophagus. Bezoars are usually caused by an altered gastric physiology, with impaired gastric emptying as a result of surgery, such as subtotal gastrectomy, antrectomy or truncal vagotomy with pyloroplasty. The treatment of bezoars depends on their composition and location. A gastric bezoar can be treated by endoscopic removal, although not all cases can be completely removed. Small bowel bezoars are usually discovered on exploration due to an intestinal obstruction, with surgical removal being the standard treatment method in such cases. CONCLUSION: A bezoar occurs mainly in patients who have previously undergone a gastric operation. Surgeons should keep in mind the possibility of bezoars in patients presentingan intestinal obstruction following a past gastric operation. The treatment principle for bezoars used to be surgery, but recently gastric bezoars are often treated by gastrofiberscopy.
Abdomen, Acute ; Animals ; Bezoars* ; Esophagus ; Female ; Gastrectomy ; Gastric Emptying ; Gastrointestinal Tract ; Humans ; Ileum ; Intestinal Obstruction ; Male ; Medical Records ; Physiology ; Retrospective Studies ; Stomach ; Vagotomy, Truncal ; Vegetables

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

A total of 30 cases of the peptic ulcer in children, who underwent operations from January 1981 to December 1995 because of complications at Department of the Surgery, Chonbuk National University Medical School, is reviewed. Twenty-three were males (76.7%), 7 females (23.3%) and male was preponderant at 3.3:1. There were 25 cases (83.3%) age 10 to 15 years, 3 (10.0%) between 2 and 9 years, and 2 (6.7%) below 2. The ulcer was located at duodenum in 27 (90.0%), and at stomach in 3 cases (10.0%). Complications were perforation in 19 cases (63.3%), pyloric obstruction in 9 (30.0%) and bleeding in 2 (6.7%). For perforation, truncal vagotomy with pyloroplasty was done in 11 cases, truncal vagotomy with hemigastrectomy and gastrojejunostomy in 6, and simple closure in 2 cases. For obstruction, truncal vagotomy with hemigastrectomy and gastrojejunostomy was done in 5, and truncal vagotomy and pyloroplasty in 3 cases. For bleeding lesions, truncal vagotomy and pyloroplasty was performed in 2 cases. Ten postoperative complications developed in 9 patients; adhesive ileus in 5, recurrence in 2, pneumonia 2, and wound seroma 1 case. One patient developed a primary duodenal perforation and another a recurrent obstruction. Both of patients had symptoms for more than 3 years and were treated with truncal vagotomy and pyloroplasty for the primary operations. Hospital stay was 11.5 days for the patient with perforated ulcer, 11.0 days for the patient with pyloric obstruction, and 14.5 days for the child with bleeding. Average hospital period was 11.6 days. To reduce recurrences after operation, extensive procedure such as distal gastrectomy with vagotomy at the first operation should be considered in case with severe complication or with patients who have been symptomatic for long periods.
Adhesives ; Child* ; Duodenum ; Female ; Gastrectomy ; Gastric Bypass ; Hemorrhage ; Humans ; Ileus ; Jeollabuk-do ; Length of Stay ; Male ; Peptic Ulcer* ; Pneumonia ; Postoperative Complications ; Recurrence ; Schools, Medical ; Seroma ; Stomach ; Ulcer ; Vagotomy ; Vagotomy, Truncal ; Wounds and Injuries

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

PURPOSE: In treating carcinoma of the esophagus, a gastric drainage procedure seems to be necessary with esophago gastrostomies because of the inevitable incidental bilateral truncal vagotomy which occurs during the esophagectomy. There are potential hazards with a pyloroplasty such as jeopardizing the blood supply to the mobilized stmach, shortening its length for substitution, leakage, dumping syndrome, and bile reflux gastritis. The aims of the study are to compare the postoperative outcome of patients with and without pyloroplasty after an esophagectomy for esophageal cancer, and to evaluate the necessity of pyloroplasty in the vagotomized intrathoracic stomach after esophageal surgery. METHODS: During the years 1996 to 2001, 23 patients with carcinoma of the esophagus underwent an esophagectomy followed by esophagogastrostomy with or without pyloroplasty. The medical records of the patients were evaluated retrospectively. RESULTS: There were no statiscally significant differences between the pyloroplasty group and the no-pyloroplasty group with regards to the average hospital stay, resumption of oral feeding, removal of the nasogastric tube, and the daily gastric drainage. CONCLUSION: Postoperative symptomatic evaluation of patients who had esophageal cancer and underwent an esoph-agectomy and an esophagogastrostomy, with or without pyloroplasty supports the concept that the drainage procedure is unnecessary in the gastric replacement of the esophagus.
Bile Reflux ; Drainage ; Dumping Syndrome ; Esophageal Neoplasms ; Esophagectomy* ; Esophagus* ; Gastritis ; Gastrostomy ; Humans ; Length of Stay ; Medical Records ; Retrospective Studies ; Stomach ; Vagotomy, Truncal

BACKGROUND: The aim of this study is to show the effectiveness and the safety of laparoscopic surgery for the treatment of complicated duodenal ulcers. METHODS: From September 1994 to July 1997, 30 hemodynamically stable patients underwent laparoscopic surgery for the treatment of complicated duodenal ulcers, including 13 free perforations, 12 obstructions and 5 intractabilities. Operations consisted of a truncal vagotomy with a drainage procedure, a proximal gastric vagotomy (posterior truncal vagotomy with anterior seromyotomy) and simple closure of the perforation in 16, 9, 5 cases, respectively. In the beginning of this study, congo-red tests were attempted in 12 patients, intraoperatively in 7 and postoperatively in 5, to assess the reliability of a laparoscopic vagotomy. Long-term follow up was evaluated using by modified Visik criteria. RESULTS: The mean operation time was 150 (80-230) minutes. Oral intake resumed on the third postoperative day. The mean hospital stay was 8.4 days. There was one intraoperative open conversion. In another case, a distal subtotal gastrectomy followed due to persistent postoperative gastric stasis. Six of 7 intraoperative congo red tests showed black-to-red discoloration of the gastric mucosa, which meant reduced gastric acidity. However, in the postoperative group, only 2 of 5 cases did. The mean follow-up period was 21 (3-38) months. There were 2 recurrent ulcers. One was on the duodenum; the other was a marginal ulcer. CONCLUSIONS: Laparoscopic surgery for the treatment of complicated duodenal ulcers is technically feasible, effective, and safe.
Congo Red* ; Congo* ; Drainage ; Duodenal Ulcer* ; Duodenum ; Follow-Up Studies ; Gastrectomy ; Gastric Acid ; Gastric Mucosa ; Gastroparesis ; Humans ; Laparoscopy ; Length of Stay ; Peptic Ulcer ; Ulcer ; Vagotomy* ; Vagotomy, Proximal Gastric ; Vagotomy, Truncal