You are here

Home » Content

DUMPİNG SENDROMU(DS) VE BİRLİKTE OLAN ALKALEN REFLÜ GASTRİT SENDROMU (ARGS) İÇİN DÜZELTİCİ AMELİYATLAR

Journal Name:

  • Cerrahpaşa Tıp Dergisi

Publication Year:

  • 2003

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Many different remedial operation for dumping syndrome and associated alkaline reflux gastritis have been considered. No controlled trials have compared the relative efficiency of these operations. Analysis of their efficiency is difficult, because while many of the procedures have good early results, there are long term failures due to complications. Materials and Methods.- Clinical features and results of remedial operations of 21 patients with dumping syndrome and associated alkaline reflux gastritis syndrome treated between 1989 to 2001 were reviewed retrospectively. Preoperatively all patients who had symptoms were evaluated by upper gastrointestinal series, endoscopy and radionuclide scanning. Long term clinical follow-up data for all patients was collected by reviewing medical records, interviewing patients directly or through telephone call or both. Visick scale was used for clinical assessment. Results.- Among 21 patients,19 could be followed. Roux-en-Y gastrojejunostomy was succcesful in 10 patients, who had Visick-I and Visick-II scale. Roux stasis syndrome was developed in 1 patient. Near-total gastrectomy was performed in 1 patient due to stasis syndrome. Conclusions.- For patients with medically unresponsive, severe dumping and dumping/alkaline reflux gastritis symptoms, we recommend the following strategy: a) For patients with pyloroplasty, pyloric reconstruction should be the initial remedial operation, b) For patients with truncal vagotomy plus gastrojejunostomy, gastrojejunostomy should be taken down in initial remedial approach. c) For patients with prior Billroth-I or Billroth-II gastrectomy, Roux-en-Y conversion is the most effective corrective operation, although it has its own problems including Roux stasis syndrome.
Bookmark/Search this post with
Abstract (Original Language): 
Dumping sendromu ve dumping sendromu ile birlikte olan alkalen reflü gastrit sendromu için çok sayıda farklı düzeltici ameliyat tarif edilmiştir. Bu ameliyatların nisbi etkinliğini mukayese eden kontrollu çalışmalar yoktur. Onların etkinliğinin analizi güçtür, çünkü, bu düzeltici ameliyatlarının çoğunun erken sonuçları iyi olmakla birlikte geç dönem sonuçları başarısız olabilir. 1989-2001 yılları arasında tedavi edilmiş, Dumping sendromu ve Dumping sendromu ile birlikte alkalen reflü gastrit sendromu olan toplam 21 hastanın klinik özellikleri ve düzeltici ameliyat sonuçları, retrospektif olarak incelenmiştir. Ameliyat öncesi tüm hastalarda üst gastrointestinal grafiler, endoskopi ve sintigrafik muayene yapılmıştır. Hastaların uzun evre klinik takip bilgileri, hastane müşahadelerin gözden geçirilmesi, hastalarla doğrudan görüşme veya telefonla öğrenilmiştir. Klinik değerlendirme için Visick skalası kullanılmıştır. 21 hasta arasında 19’unda geç dönem sonuçları öğrenilmiştir. Roux-en-Y gastrojejunostomi 10 hastada başarılı bulunmuştur. Bir hastada Roux staz sendromu gelişmiştir. Bu hastada Near-total gastrektomi uygulanmıştır. Medikal tedaviye cevap alınamayan ağır dumping ve dumping/alkalen reflü gastrit sendromlu hastalar için edindiğimiz tecrübeler ve literatür ışığında aşağıdaki stratejiyi öneriyoruz: a) Piloroplastili hastalar için kendi deneyimimiz olmamasına rağmen pilor rekonstrüksiyonu, b) Primer ameliyatında gastrojejunostomili hastalarda gastrojejunostomili iptali en basit ve fizyolojik yöntem olarak görünmektedir. c) Primer ameliyatında Billroth-I veya Billroth- II uygulanmış hastalarda Roux-en-Y konversiyonu Roux staz sendromu gibi komplikasyonlarına rağmen en etkili düzeltici ameliyattır.
FULL TEXT (PDF): 
PDF icon arastirmax-dumping-sendromuds-birlikte-olan-alkalen-reflu-gastrit-sendromu-args-icin-duzeltici-ameliyatlar.pdf
  • 3
132-139
  • Turkish

REFERENCES

References: 

1. Woodward ER, Hocking MP. Postgastrectomy
syndromes. Surg. Clin .N.Am. 1987; 67: 509-29
2. Miedema BW, Kelly KA. The Roux operation for
postgastrectomy syndromes. Am J Surg. 1991; 161: 256-
61
3. Hall R. Arthur Hedley Clarence Visick FRCS.1987-1949.
Ann Royal Coll Surg Engl. 1986; 68: 147-51
CERRAHPAŞA TIP DERGİSİ Cilt (Sayı) 34 (3)
138
4. Neter J, Wasserman W, Whitmore GA. Kalmogorov-
Smirnov statistics. In Applied Statistics: Third edition,
Massachusetts, Allyn and Bacon İnc 1988; 536-41
5. Gustavsson S, Kelly KA, Melton LJ. Trends in peptic
ulcer surgery: A population based study in Rochester,
Minnesota, 1956-1985. Gastroenterology, 1988; 96: 688-
96
6. Paimela H, Tuompa PK, Perakyla T. Peptic ulcer surgery
during the H2 –receptor antagonist era: A populationbased
epidemiological study of ulcer surgery in Helsinki
from 1972 to 1987. Br J Surg 1991; 78: 28-31
7. Eagon JC, Miedema BW, Kelly KA. Postgastrectomy
syndromes.Surg Clin N Am. 1992; 72: 445-65
8. Thompson JC, Weiner T. Evaluation of surgical
treatment of duodenal ulcer: Short and long term
effects.Clin Gastroenterol 1984;13: 569-600
9. Misumi H, Hanada K, Murakami A. Postoperative results
of distal partial gastrectomy, selective vagotomy plus
antrectomy and selective proximal vagotomy for
duodenal ulcers. Jpn J Surg. 1989; 19: 708-17
10. Donahue PE, Bombeck CT,.Condon RT. Proximal gastric
vagotomy versus selective vagotomy with antrectomy:
Results of a prospective randomized clinical trial after
four to twelve years. Surgery, 1984; 96: 585-90
11. Jordan GL Jr, Bolton BF, DeBakey ME. Experience with
gastrectomy at veterans hospital. JAMA, 1956; 161:
1605-8
12. Harvey DH, John FB, Volk H. Peptic ulcer: Late followup
results after partial gastrectomy. Analysis of failures.
Arch Surg.1958; 138; 680-88
13. Hastings N, Nalsted JA, Woodward ER, Gesster M,
Hiscock EA. Subtotal gastric resection for benign gastric
ulcer. Arch Surg. 1958; 76: 74-80
14. Johnston D, Blackett RL: A new look at selective
vagotomies. Am J.Surg 1988; 156: 416-27
15. Eisenberg MM, Woodward ER. Vagotomy and drainage
procedure for duodenal ulcer: The results of ten years
experience. Ann Surg. 1969; 170: 785-92
16. O’Leary JP, Woodward Hollanbeck JI. Vagotomy and
drainage procedure for duodenal ulcer: The results of
seventeen years experience. Ann Surg. 1976; 183: 613-18
17. Hartley MN, Mackie CR. Gastric adaptive relaxation and
symptoms after vagotomy Br J.Surg. 1991; 78: 24-7
18. Mistianen W, Van Hee R, Black P. Gastric emptying for
solids in patients with duodenal ulcer before and after
highly selective vagotomy. Dig Dis Sci 1990; 35: 310-16
19. Goligher JC, Hill GL, Kenney TE. Proximal gastric
vagotomy without drainage for duodenal ulcer: Results
after 5-8 years. Br J Surg 1978; 65: 145-51
20. Carvajal SH, Mulvihil SJ. Postgastrectomy syndromes:
Dumping and diarrhea Gastroenterol Clin N Am 1994;
23: 261-79
21. Machella TE. The mechanism of the postgastrectomy
dumping syndrome.Ann Surg 1949; 130: 145-59
22. Roberts KE, Randall HT, Farr HW. Cardiovascular and
blood volume alterations resulting from intrajejunal
administrations of hypertonic solutions to gastrectomized
patients: The relationship of these changes to the
dumping syndrome. Ann Surg 1954; 140: 631-40
23. 23.Drapanas T, Mc Donald JC, Stewart JD. Serotonine
release following instillation of hypertonic glucose into
the proximal intestine. Ann Surg 1962; 156: 528-36
24. Sagor GR, Bryant MG, Ghatei MH. Release of
vasoactive intestinal peptide in the dumping syndrome.
Br M J 1981; 282: 507-10
25. Sirinek KR, O’Dorisio TM, Howe B. Neurotensine,
vasoactive intestinal peptide and Roux-en-Y
gastrojejunostomy: Their role in the dumping syndrome.
Arch Surg. 1985; 120: 605-9
26. Geer RJ, Richards WO, O’Dorisio TM. Efficacy of
octreotide acetate in the treatment of severe
postgastrectomy dumping syndrome.Ann Surg. 1990;
212: 678-87
27. Thor K, Rosell S. Neurotensin increases colonic motility.
Gastroenterology 1986; 90: 27-31
28. Mehagnoul-Schipper DJ, Lenders JW, Willemsen JJ,
Hopman WP. Sympathoadrenal activation and dumping
syndrome after gastric surgery.Clin Auton Res 2000; 10:
301-8
29. Leeds AR, Ralphs DN, Ebied F. Pectin in the dumping
syndrome: Reduction of symptoms and plasma volume
changes.Lancet, 1981; 1: 1075-78
30. Harju E, Larmi TK. Efficacy of guar gum in preventing
the dumping syndrome. J Parent Enteral Nutr. 1983; 7:
470-72
31. Hopman WP, Houben PIG, Speth PA. Glucomannon
prevents postprandial hypoglycemia in patients with
previous gastric surgery. Gut, 1988; 29: 930-4
32. Primrose JN. Octreotide in the treatment of dumping
syndrome. Digestion, 1990; 45: 49-58
33. Gray JL, Debas HT, Mulvihil SJ. Control of dumping
symptoms by somatostatine analogue in patients after
gastric surgery. Arch Surg 1991; 126: 1231-36
34. Witt K, Pederson NT. The long-acting somatostatine
analogue SMS 201-995 causes malabsorbtion. Scand J
Gastroenterol 1989; 24: 1248-52
35. Wass JA, Popovic V, Chagvialle JA. Proceedings of the
discussion “Tolerability and safety of Sandostatine”.
Metabolism, 1992; 41: 80-2
Temmuz-Eylül 2003 DUMPİNG SENDROMU; ERSAN VE ARK.
139
36. Porter HW, Claman ZB. A preliminary report on the
advantages of a small stoma in partial gastrectomy for
ulcer.Ann Surg 1964; 160: 488
37. Herrington JL, Sawyers JL. Remedial operations. In
Wastell C, Nyhus LM, Donahue PE (eds). Surgery of the
Esophagus, Stomach and Small Intestine. Fifth ed.
Boston, Little Brown, ,1995; 542-71
38. Cheadle WG, Baker PR, Cushieri A. Pyloric
reconstruction for severe vasomotor dumping after
vagotomy and pyloroplasty. Ann Surg 1985; 202: 568-72
39. Koruth NM, Krukowski ZH, Matheson NA. Pyloric
reconstruction.Br J Surg 1985; 72: 808-10
40. Woodward ER, Hastings N. Surgical treatment of the
postgastrectomy dumping syndrome Surv Med 1960;
111: 429-37
41. Henley FA. Experiences with jejunal interposition for
correction of postgastrectomy syndromes. In Harkins HN,
Nyhus LM(eds) Surgery of the Stomach and Duodenum
Boston, Little Brown, 1969; 777.
42. Mackie CR, Hall AW, Clark J, Cushieri A. The effect of
isoperistaltic jejunal interposition upon gastric emptying.
Surg Gynecol Obstet 1981; 153: 813-9
43. Nygaard K, Fretheim B. Jejunal transposition in the
treatment of postgastrectomy syndromes. Scand J
Gastroenterol 1971; 9: 59-64
44. Alexander-Williams J. Gastric reconstructive surgery.
Ann R Coll Surg 1973; 51:1-17
45. Fenger H, Godmand-Houer E, Kallehauge H, Andersen
M. Clinical experience with isoperistaltic interposition of
jejunal segment for incapacitating dumping syndrome.
Ann Surg 1972; 175: 274-78
46. Sawyers JL, Herrington JL Jr. Superiority of
antiperistaltic jejunal segments in the management of
severe dumping syndrome. Ann Surg 1973; 178: 311-21
47. Morii Y, Arita T, Shimoda K, Matsui Y, İnomata M,
Kitama S. Jejunal interposition to prevent
postgastrectomy syndromes.Br J Surg 2000; 87:1576-79
48. Poth EJ. Surgical correction of severe dumping and
postgastrectomy nutrition Ann Surg 1964; 160: 488-96
49. Jordon GL. Surgical management of postgastrectomy
problems. Arch Surg1971; 102: 251
50. Benedini E. Surgical treatment of dumping syndrome
after gastroduodenal resection Int Surg1980; 65; 419-22
51. Sawyers JL, Herrington JL, Buckpan GS. Remedial
operation for alkaline reflux gastritis and associated
postgastrectomy syndromes. Arch Surg 1980; 115: 519-
23
52. Miranda R, Steffes B, O’Leary JP, Woodward ER.
Surgical treatment of the postgastrectomy dumping
syndrome. Am J Surg 1980; 139: 40-3
53. Hocking MP, Vogel SB. Woodward’s Postgastrectomy
Syndromes. Philadelphia, WB Saunders ,1991; 199
54. Vogel SB, Hocking MP, Woodward ER. Clinical and
radionuclide evaluation of Roux-Y diversion for
postgastrectomy dumping. Am. J Surg 1988; 155: 57-62
55. Karlstrom L, Soper NJ, Kelly KA. Ectopic jejunal
pacemakers and enterogastric reflux after Roux
gastrectomy. Surgery 1989; 106: 486-95
56. Fich A, Neri M, Camilleri M. Stasis syndromes following
gastric surgery: Clinical and motility features of 60
symptomatic patients. J Clin Gastroenterol 1996; 12: 505-
12
57. Gustavsson S, Ilstrup DM, Morison P, Kelly KA. Roux-
Y stasis syndrome after gastrectomy. Am J Surg 1988;
155: 490-94
58. Hinder RA, Esser J, De Meester TR. Management of
gastric emptying disorders following the Roux-en-Y
procedure. Surgery, 1988; 104: 765-72
59. Van Stiegmann G, Goff JS. An alternative to Roux-en-Y
for treatment of bile reflux gastritis. Surg Gynecol Obstet
1988; 166: 69-70
60. Nakane Y, Akehira K, Inoue K., Liyama H, Sato M,
Masuya Y, Okumura S, Yamanichi K, Hioki K.
Postoperative evaluation of pylorus-preserving
gastrectomy for early gastric Cancer.
Hepatogastroenterology 2000; 47: 590-5
61. Sasakı I, Fukushima K, Naito H, Matsune S. Long-term
results of pylorus-preserving gastrectomy for gastric
ulcer.Tohuku J Exp Med 1992; 168: 539-48

Thank you for copying data from http://www.arastirmax.com