Clinical and histological sequelae of Roux-en-Y diversion

Hollands, Michael; Filipe, I.; Edwards, SJ; Brame, K.; Maisey, M. N.; Owen, William J.

doi:10.1002/bjs.1800760518

Cited by 13 publications

(4 citation statements)

References 34 publications

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“…The median follow-up was 12 years (Åhsberg, Hammar, Stae ¨l von Holstein, in press). This is in contrast to the results in previously published studies where improvement was seen for some precancerous changes [67][68][69], though most histologic changes remained unchanged [68 -70]. The follow-up time in those studies varied from 6 months to around 4 years.…”

Section: Pathogenesis Of Stump Carcinoma: Impact Of Bile Refluxcontrasting

confidence: 71%

Long‐term Prognosis after Partial Gastrectomy for Gastroduodenal Ulcer

Holstein

2000

World j. surg.

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The decline in duodenal ulcer disease and the established relation of peptic ulcer to Helicobacter pylori have virtually abolished the need for elective ulcer surgery. However, a substantial proportion of the population around retirement age has previously been subjected to partial gastric resection due to peptic ulcer, and the long-term outcome of these patients is of continuing relevance. Patients subjected to elective surgery could represent a selected group of healthy subjects with a lower overall morbidity, but reports indicate that patients operated on for peptic ulcer have more advanced disease associated with excess smoking and a different pattern of social behavior. The surgical procedure induces enterogastric reflux, leading to profound changes in the remnant mucosa and the formation of carcinogens in the gastric juice. In addition, metabolic abnormalities are common, especially fat malabsorption. Evaluation of the impact of these factors on morbidity and mortality is difficult. Increased mortality in gastrointestinal tumors (especially gastric stump carcinoma), respiratory diseases and other smoking-related malignancies, and suicide are found in the long-term follow-up after partial gastric resection due to peptic ulcer. However, these hazards to life are offset by a decreased mortality in cardiovascular disease. Preventive measures against suicide and especially tobacco smoking are recommended to improve th outcome for this cohort.

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Section: Pathogenesis Of Stump Carcinoma: Impact Of Bile Refluxcontrasting

confidence: 71%

Long‐term Prognosis after Partial Gastrectomy for Gastroduodenal Ulcer

Holstein

2000

World j. surg.

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“…The mean(s.e.m.) DeMeester score was 31.1 (4)(5)(6)(7)(8)(9). The percentage of time at which absorbance was greater than 0.15 in the supine period did not differ from that in controls (Table I ) .…”

Section: Groupmentioning

confidence: 85%

Ambulatory oesophageal bile reflux monitoring in Barrett's oesophagus

Caldwell

Lawlor

Byrne

et al. 1995

Journal of British Surgery

111

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Bile reflux has been implicated in the pathogenesis of Barrett's oesophagus but evaluation remains difficult. Bilitec 2000 is an ambulatory system that detects bilirubin based on its spectrophotometric properties. Oesophageal bile exposure was evaluated in three groups of patients. Group 1 (n = 11) were normal controls, group 2 (n = 13) were patients with uncomplicated gastro-oesophageal reflux and group 3 (n = 12) were patients with Barrett's oesophagus. Bile reflux was greater in patients with Barrett's mucosa than in controls or those with uncomplicated reflux. This difference was seen in the supine and interdigestive periods. The percentage of time at which gastric pH was greater than 4 and oesophageal pH was above 7 did not differ between the groups. Bilitec 2000 detects greater bile reflux in patients with Barrett's oesophagus. No corresponding gastric or oesophageal alkaline shift is found. This ambulatory bile reflux monitoring system may be a useful tool in clinical practice.

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“…Bile reflux is well recognised as a factor associated with the induction of acute pancreatitis, particularly when associated with sepsis [12, 13]. Reflux of both bile and intestinal contents is prevented by the use of a long isolated Roux loop reconstruction [14, 15]. In 1994 Kingsnorth [16] reported no pancreatic leaks in a series of 52 patients undergoing PD when performing a duct-to-mucosa anastomosis with this reconstructive technique.…”

Section: Introductionmentioning

confidence: 99%

Isolated Roux Loop Duct-to-Mucosa Pancreaticojejunostomy Avoids Pancreatic Leaks in Pancreaticoduodenectomy

Khan

Agarwal²,

Davidson³

2002

Dig Surg

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Background: Over the last decade the operative mortality associated with pancreaticoduodenectomy (PD) has decreased. Pancreatic anastomotic leaks resulting in pancreatic bed sepsis and fistulae, however, remain a significant cause of both morbidity and mortality. The optimal method of reconstruction to minimise pancreatic leaks is controversial. Aim: To review the experience of Roux loop duct-to-mucosa pancreaticojejunostomy in a consecutive series of patients undergoing pancreatic head resection. Methods: Over the 6-year period (1993–1998), 41 patients underwent pancreatic head resections for benign (n = 5) and malignant disease (n = 36). There were 19 males and the median age was 62 years (range 29–83). An isolated Roux loop pancreaticojejunostomy was performed in all cases. Results: Median duration of surgery was 8 h and the median postoperative stay was 16 days. The mean peri-operative blood transfusion was 2.9 units (SD 1.9). The incidence of major complications was 12% and there was 1 death (2.4%). There were no pancreatic leaks or fistulae. Conclusions: The low complication rate and the absence of pancreatic fistulae in this series would suggest that Roux loop duct-to-mucosa pancreatic reconstruction should be more widely adopted.

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Clinical and histological sequelae of Roux-en-Y diversion

Cited by 13 publications

References 34 publications

Long‐term Prognosis after Partial Gastrectomy for Gastroduodenal Ulcer

Long‐term Prognosis after Partial Gastrectomy for Gastroduodenal Ulcer

Ambulatory oesophageal bile reflux monitoring in Barrett's oesophagus

Isolated Roux Loop Duct-to-Mucosa Pancreaticojejunostomy Avoids Pancreatic Leaks in Pancreaticoduodenectomy

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