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

OBJECTIVETo investigate the retrograde changes in the dorsal motor nuclei (DMV) of the vagus nerve after vagotomy in rats.

METHODSNissl staining and immunohistochemistry were used to observe the morphological and quantitative changes of the DMV and alterations of the expression of iNOS and NADPH after severing of the vagus nerve in adult male Wistar rats.

RESULTSCompared with the control group, the rats with right vagotomy showed obvious morphological changes and a significantly decreased number of neurons in the right DMV (P<0.05). Numerous iNOS- and NADPH-immunopositive cells were detected in the right DMV 5 and 10 days after right vagotomy.

CONCLUSIONVagotomy causes obvious retrograde changes in rat DMV shown by a significantly decreased number and obvious morphological changes of the neurons in the DMV.

Animals ; Male ; NADP ; metabolism ; Neurons ; metabolism ; Nitric Oxide Synthase Type II ; metabolism ; Rats ; Rats, Sprague-Dawley ; Vagotomy ; Vagus Nerve ; pathology ; physiopathology ; surgery

BACKGROUNDL-glutamate (L-GLU) is a major neurotransmitter in the nucleus ambiguus (NA), which can modulate respiration, arterial pressure, heart rate, etc. This study investigated the effects and mechanisms of L-GLU microinjected into NA on gastric motility in rats.

METHODSA latex balloon connected with a pressure transducer was inserted into the pylorus through the forestomach for continuous recording of the gastric motility. The total amplitude, total duration, and motility index of gastric contraction waves within 5 minutes before microinjection and after microinjection were measured.

RESULTSL-GLU (5 nmol, 10 nmol and 20 nmol in 50 nl normal saline (PS) respectively) microinjected into the right NA significantly inhibited gastric motility, while microinjection of physiological saline at the same position and the same volume did not change the gastric motility. The inhibitory effect was blocked by D-2-amino-5-phophonovalerate (D-AP5, 5 nmol, in 50 nl PS), the specific N-methyl-D-aspartic acid (NMDA) receptor antagonist, but was not influenced by 6-cyaon-7-nitroquinoxaline-2,3-(1H,4H)-dione (CNQX) (5 nmol, in 50 nl PS), the non-NMDA ionotropic receptor antagonist. Bilateral subdiaphragmatic vagotomy abolished the inhibitory effect by microinjection of L-GLU into NA.

CONCLUSIONSMicroinjection of L-GLU into NA inhibits the gastric motility through specific NMDA receptor activity, not non-NMDA receptor activity, and the efferent pathway is the vagal nerves.

2-Amino-5-phosphonovalerate ; pharmacology ; 6-Cyano-7-nitroquinoxaline-2,3-dione ; pharmacology ; Animals ; Gastrointestinal Motility ; drug effects ; Glutamic Acid ; administration & dosage ; pharmacology ; Male ; Medulla Oblongata ; drug effects ; metabolism ; Rats ; Rats, Wistar ; Receptors, N-Methyl-D-Aspartate ; antagonists & inhibitors ; Vagotomy

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: 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

Gastroparesis is a clinical term for gastric dysmotility or paralysis that presents without mechanical obstruction, but with functional obstruction. Nausea, vomiting, abdominal discomfort and abdominal distension may result from the functional obstruction of gastroparesis. Gastroparesis is frequently associated with such systemic diseases as diabetic mellitus and scleroderma or with certain operations such as vagotomy. Yet gastroparesis is rarely described in older children after viral infection. The authors observed a case of gastroparesis after pyretic symptoms. We report here on this case and its clinical consequences.
Child ; Gastroparesis ; Humans ; Nausea ; Paralysis ; Vagotomy ; Vomiting

OBJECTIVETo evaluate the long-term therapeutic efficacy of extended parietal cell vagotomy (EPCV) in the treatment of duodenal ulcer complicated with acute perforation.

METHODSTherapeutic efficacy of EPCV in 176 cases subjected to duodenal ulcer with acute perforation since 1979 was evaluated, including postoperative complication, ulcer recurrence rate, gastric empting function, endoscopic and radiographical examination, nutritional status and Visick classification.

RESULTSAmong 176 patients, 153 (86.9%) cases were successfully followed-up for 5 years after operation. No operative death was found. Postprandial superior belly fullness occurred in 13 cases (8.5%) and heartburn in 12 cases (7.8%), which could be relieved by Domperidone. Adhesive ileus was noted in 4 cases (2.6%) which was cured by adhesiolysis. The total ulcer recurrence rate was 2.6% (4 cases) within 2 to 3 years after operation. Superficial gastritis occurred in 21 cases (13.7%) and duodenal bulb in 31 cases (20.3%). Sinus ventriculi vermicular motion was good and gastric emptying was normal. No anemia was found. Body weight gained in 116 cases (75.8%). One hundred and forty-six cases(95.4%) were reforming Visick grade I and II , 3 cases(2.0%) grade III , and 4 cases (2.6%) IV .

CONCLUSIONSEPCV is convenient for performance with low postoperative complication rate. Its long-term efficacies are quite good, which including normal nutritional status, high quality of life and low ulcer recurrence rate. EPCV is one of effective and safe treatments for duodenal ulcer complicated with acute perforation.

Adolescent ; Adult ; Aged ; Duodenal Ulcer ; complications ; surgery ; Female ; Humans ; Male ; Middle Aged ; Peptic Ulcer Perforation ; etiology ; surgery ; Treatment Outcome ; Vagotomy, Proximal Gastric ; Young Adult

A mushroom bezoar is an unusual type of bezoar and a rare cause of small bowel obstruction, with the only cases being previously described in the foreign literature. Common sites of obstruction are the gastric outlet, the terminal ileum as well as segments of pre-existing gastrointestinal stenosis of various etiologies. Predisposing factors include a high fiber intake, inadequate chewing, gastric hyposecretion and hypomotility, and a previous gastrectomy and vagotomy. Computed tomography has the capability of directly showing the bezoar and displaying the resulting small bowel obstruction. We report a case of incomplete small bowel obstruction in a 38-year-old woman, caused by a mushroom bezoar in the terminal ileum.
Adult ; Agaricales* ; Bezoars* ; Causality ; Constriction, Pathologic ; Female ; Gastrectomy ; Humans ; Ileum ; Mastication ; Vagotomy

Gastrojejunocolic fistula (GJCF) is mainly thought to be a late complication of inadequate gastric surgery such as insufficient gastric resection or inappropriate vagotomy. The pathogenesis of fistula formation has been accounted to the perforation of a retained jejunal marginal ulcer into the transverse colon. Most patients with GJCF present a common symptom triad of faecal vomiting, chronic diarrhea and weight loss. We recently experienced a patient with GJCF who had been suffering from diarrhea for a long period of time. He had undergone gastric surgery 8 years previously for peptic ulcer disease at another hospital. After detailed preoperative evaluation with duodenoscopy, upper gastrointestinal series, colonofiberscopy, barium enema and abdominal CT, he underwent surgery-resection of the gastric stump and segmental resection of the jejunum and transverse colon with Roux-en-Y gastrojejunostomy. Recent advances in surgical technique such as vagotomy, and medical therapy have remarkably decreased the incidence of both stomal ulcer and GJCF in peptic ulcer disease. However, gastrojejunocolic fistula should be recognized as one of the late severe complications observed after a gastrectomy with Billroth-II reconstruction, since this disease may occur even 20 years after the first operation. We report the case of a 52-year old man with gastrojejunocolic fistula with review of the literature.
Barium ; Colon, Transverse ; Diarrhea ; Duodenoscopy ; Enema ; Fistula* ; Gastrectomy* ; Gastric Bypass ; Gastric Stump ; Humans ; Incidence ; Jejunum ; Middle Aged ; Peptic Ulcer ; Tomography, X-Ray Computed ; Ulcer ; Vagotomy ; Vomiting ; Weight Loss