Experimental and Clinical Results with Proximal End-to-End Duodenojejunostomy for Pathologic Duodenogastric Reflux

DeMeester, Tom R.; Fuchs, Karl Hermann; Ball, Chris S.; Albertucci, Mario; Smyrk, T. C.; Marcus, Joseph

doi:10.1097/00000658-198710000-00003

Cited by 204 publications

(71 citation statements)

References 34 publications

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“…It was obvious from findings on CT that resection of the gastric remnant would require thoracotomy, which must be invasive for 80-year-old patient. Therefore, we decided to perform duodenal switch (DeMeester et al 1987) as a surgical treatment for pathologic DGR.…”

Section: Discussionmentioning

confidence: 99%

“…A couple of studies reported the efficacy of duodenal switch for DGR secondary to gastric surgery, but these reports does not include patients after PG (DeMeester et al 1987;Strignano et al 2007). Roux-en-Y anastomosis is also effective to divert duodenal content after distal gastrectomy with Billorth-II anastomosis or vagotomy + pyloroplasty, or in patients with complex peptic esophagitis (Davidson and Hersh 1980;Cabrol et al 1990;Fékété et al 1997;Topart and Vandenbroucke 2001;Zobolas et al 2006).…”

Section: Discussionmentioning

confidence: 99%

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Duodenal Switch for Intractable Reflux Gastroesophagitis after Proximal Gastrectomy

Someya

Shibata

Tanaka

et al. 2013

Tohoku J. Exp. Med.

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Reflux gastroesophagitis is a common postgastrectomy complication after proximal gastrectomy, and conservative treatments including protease inhibitors and proton pump inhibitors are effective in most patients. Here we report a patient with severe reflux gastroesophagitis after proximal gastrectomy, in whom surgical treatment of duodenal switch was effective. An 80-year-old man complained of intractable heartburn, anorexia, and body weight loss after having undergone proximal gastrectomy, with reconstruction by esophagogastrostomy with valvuloplasty and pyloroplasty, for early gastric cancer 14 months before referral to our department. Oral administration of protease inhibitors and proton pump inhibitors was ineffective. Laboratory evaluation showed poor nutritional status. On endoscopic examination, we noted the redness, bleeding, and multiple erosions in the esophagus and the gastric remnant. He was diagnosed to have severe gastroesophagitis due to reflux of duodenal juice into the gastric remnant and esophagus. We performed duodenal switch to divert duodenal juice from the gastric remnant and esophagus; the duodenum was transected 2 cm distal to the pylorus, the duodenal distal end was closed, and a 50-cm Roux limb from the proximal jejunum was anastomosed to the proximal end of the duodenum. The heartburn disappeared postoperatively, and endoscopic examination revealed marked improvement of the reflux gastroesophagitis. One year postoperatively, the patient is free from symptoms including heartburn. His body weight increased, and laboratory data showed improvement in nutritional status. In conclusion, the duodenal switch may be surgical treatment of choice for intractable reflux gastroesophagitis after proximal gastrectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Duodenal Switch for Intractable Reflux Gastroesophagitis after Proximal Gastrectomy

Someya

Shibata

Tanaka

et al. 2013

Tohoku J. Exp. Med.

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“…We have adopted truncal vagotomy with antrectomy and Roux-en-Y gastrojejunostomy because of our familiarity with the technique, and there are several comparisons in the literature [3, 5, 17, 18]. However, the procedures currently adopted are extramucous duodenal myotomy described by Pandolfo et al [5] and duodenal switch described by DeMeester [6, 19]. Extramucous duodenal myotomy potentiates the emptying of the stomach by weakening the resistance that the duodenum poses to the antral propulsive push.…”

Section: Discussionmentioning

confidence: 99%

Truncal Vagotomy, Antrectomy and Roux-en-Y Gastrojejunostomy in the Treatment of Duodenogastric Reflux Disease

Im¹,

Brisinda²,

Palermo³

et al. 1998

Dig Surg

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Background/Aims: The surgical treatment of duodenogastric reflux (DGR), resistant to medical therapy, in patients with intact stomach is difficult to standardize. The aim of this study is to present our experience on 5 patients, all cholecystectomized, with severe DGR disease treated surgically. Methods: Out of a group of 223 patients suffering from nonulcerous dispeptic pathology presenting to our department, we selected 5 patients suffering from alkaline reflux gastritis in intact stomach. The diagnosis of primary DGR was made using Wilson’s criteria. The surgical procedure adopted consisted of a truncal vagotomy, antrectomy, and a Roux-en-Y gastrojejunostomy. Results: No perioperative mortality was observed. Twelve months after surgery all patients expressed satisfaction with the result of the operation and complained of no severe disturbances. A sense of postprandial fullness with a sense of pain in the left shoulder persisted in one case only, requiring the consumption of small and frequent meals. Radiological examination of the upper gastrointestinal tract of these patients showed notably delayed emptying of the gastric stump, while the endoscopic picture was completely normal. Conclusion: The antrectomy and Roux-en-Y gastrojejunostomy is a better known operation, easily executed, and has the advantage that it can be performed on patients previously operated on for gastric resection and therefore suffering from secondary reflux. It also has the advantage of removing the gastric antrum where mucous atrophy is more frequent and is susceptible to neoplastic degeneration. However, at the present time the choice between different types of operation depends exclusively on the personal conviction and experience of the surgeon.

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“…Авторы рассмотрели возможность сохранения приврат-ника с созданием анастомоза между тонким кишечником и двенадцатиперстной кишкой вне зоны предыдущего оперативного вмешательства и адаптировали операцию выключения двенадцатиперстной кишки, предложенную T.R. DeMeester, для лечения дуодено-гастрального реф-люкса [31]. Первая операция BPD-DS с выключением двенадцатиперстной кишки была проведена мужчине, перенесшему в 1979 г. горизонтальную гастропластику.…”

Section: шунтирование желудка с гастроеюноанастомозом по руunclassified

Evolution of biliopancreatic diversion in the treatment of morbid obesity and type 2 diabetes mellitus

et al. 2017

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The prevalence of morbid obesity is on the rise. Surgical intervention for the treatment of morbid obesity has been shown to provide high metabolic efficiency, acquiring a special role in the treatment of type 2 diabetes mellitus. Various surgical procedures are used in treating morbid obesity. These include gastric-bypass surgery and biliopancreatic bypass diversion (BPD), each with various advantages of its own. In recent years, BPD (also referred to as the Scopinaro procedure) has evolved and been modified into the single anastomosis duodeno-ileal (SADI) procedure. Like other types of BPD, the SADI procedure effectively reduces excess body weight and promotes normalisation of carbohydrate and lipid metabolism, leading to a reduced frequency of insulin therapy and use of antidiabetic drugs. The potential benefits of the procedure include reduced operative time and a reduced incidence of internal hernias. Studies have also shown that the SADI procedure results in fewer early and late post-operative complications. Given the effectiveness of the procedure, it is necessary to increase the number and duration of observations made to enable further insight into the long-term efficacy and use of the SADI procedure.

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Experimental and Clinical Results with Proximal End-to-End Duodenojejunostomy for Pathologic Duodenogastric Reflux

Cited by 204 publications

References 34 publications

Duodenal Switch for Intractable Reflux Gastroesophagitis after Proximal Gastrectomy

Duodenal Switch for Intractable Reflux Gastroesophagitis after Proximal Gastrectomy

Truncal Vagotomy, Antrectomy and Roux-en-Y Gastrojejunostomy in the Treatment of Duodenogastric Reflux Disease

Evolution of biliopancreatic diversion in the treatment of morbid obesity and type 2 diabetes mellitus

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