Long-Term Results of Pylorus-Preserving Gastrectomy for Gastric Ulcer.

Abstract

The postoperative results of pylorus-preserving gastrectomy (PPG) for gastric ulcer performed in 134 patients during the past 25 years (mean postoperative period, 16.6 years) were studied. The incidence of postoperative complications was low. Dumping syndrome occurred in only 4.4% and 0% of cases as assessed by questionnaire and interview, respectively. Four (5.4%) of 74 patients available for this study had ulcer recurrence. In one of these four patients concurrent gastroduodenal ulcer was suspected from preoperative gastric analysis. The site of recurrence was found in all cases to be the remnant antral gland area along the greater curvature between the proper gastric gland area and the duodenum. Basal and maximal acid outputs at the time of relapse were significantly higher in patients with recurrence than in patients without recurrence. The fasting and postprandial serum gastrin levels were high in one patient with recurrence, whose antrum was preserved as long as 3 cm proximal to the pyloric ring ; this was longer than that described in our original method of PPG. In two other recurrent cases the serum gastrin levels were not different from those in norecurrent cases. Immunohistochemical examination of the residual antrum showed no increase in the G-cell density in patients either with or without recurrence. These results suggest that the long-term quality of life of patients treated with PPG remains favorable. Recurrence rate can be further reduced if PPG is strictly indicated for gastric ulcer only and carried out by meticulous surgical techniques. In the pathogenesis of the ulcer recurrence the role of gastrin release from the residual antral mucosa seems to be limited. pylorus-preserving gastrectomy ; long-term follow-up ; postoperative ulcer recurrence Since conventional gastrectomy involves pyloric resection, postoperative sequelae, such as dumping syndrome and other disorders of digestion and absorption may occur as a result of rapid gastric emptying. To minimize these complications, we have performed pylorus-preserving gastrectomy (PPG) for

Quality of life after laparoscopy-assisted pylorus-preserving gastrectomy: an evaluation using a questionnaire mailed to the patients

“…Prior studies [13][14][15], suggested that LAPPG would provide better QOL than LADG. Tomita et al [14] and others [23,24] report that pylorus-preserving gastrectomy (PPG) alleviates postoperative gastrointestinal symptoms, such as appetite loss, reflux esophagitis, early dumping syndrome, lost body weight, endoscopic reflux esophagitis, endoscopic gastritis in the remnant stomach, and postgastrectomy cholecystolithiasis, better than conventional distal gastrectomy.…”

“…This approach offers several advantages associated with preserving the pyloric function, such as the prevention of dumping syndrome [13], protection against bile mucosal injury of the remnant stomach [14], and less postoperative body weight loss [15]. However, LAPPG is not as widely performed as LADG, and there has been no reported comparison between non-pylorus-preserving gastrectomy and pylorus-preserving gastrectomy in settings where laparoscopic techniques are applied to the surgery, other than the report of Urishihara et al [16].…”

Phase II Study of Limited Surgery for Early Gastric Cancer: Segmental Gastric Resection

“…We note that Sawai et al 3 reported a surgical technique to preserve the pylorus during distal gastrectomy with radical lymph node dissection. Although the operation described by Sawai et al 4 is not a limited operation, the postoperative function is better than that after common operations without pylorus preservation. 4 In this study, we examine the results of SR for treatment of EGC of the middle stomach, compared with the results of DR, in terms of surgical risk, postoperative organ function, and survival rates.…”

“…Although the operation described by Sawai et al 4 is not a limited operation, the postoperative function is better than that after common operations without pylorus preservation. 4 In this study, we examine the results of SR for treatment of EGC of the middle stomach, compared with the results of DR, in terms of surgical risk, postoperative organ function, and survival rates. We also compare the results of limited lymphadenectomy of D0 -1 with the results of common dissection of D2.…”

Transectional gastrectomy: An old but renewed concept for early gastric cancer

“…10 Maki's colleagues summarized the long-term results of PPG in 1992. 11 A report on the outcomes of 134 patients followed up over 25 years revealed peptic ulcer recurrence in 5.4% and dumping syndrome in only 4.4% and 0% as determined by questionnaire and interview, respectively.…”