Nutritional effects of postgastrectomy reconstructions

Auguste, Louis‐Joseph; Mavor, Eli; Citrin, Paul; Stein, Theodore A.; Mandell, Charlotte; Wise, Leslie

doi:10.1016/0002-9610(85)90432-5

Cited by 21 publications

(7 citation statements)

References 6 publications

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“…2 However, the small intestine could be viewed as a much larger reservoir for food than the stomach. Further, creating an intestinal reservoir after total gastrectomy, a so-called pouch reconstruction, did not increase postoperative food intake and body weight 3,30,47,48 and did not improve symptoms of eating dysfunction after gastrectomy. 30 Therefore, based on the data presented, not a lack of reservoir but rather early satiety due to a disturbed central regulation of food intake should be considered as a key factor for reduced food intake and body weight loss after total gastrectomy.…”

Section: Regulation Of Food Intake After Total Gastrectomy In Ratsmentioning

confidence: 99%

Total Gastrectomy Severely Alters the Central Regulation of Food Intake in Rats

Zittel¹,

Glatzle²,

Müller³

et al. 2002

Annals of Surgery

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ObjectiveTo investigate the central regulation of food intake by quantifying neuron activation of the nucleus of the solitary tract (NTS) after injection of cholecystokinin (CCK) or food intake in gastrectomized rats. Summary Background DataTotal gastrectomy is followed by early satiety, low calorie intake, and weight loss in the majority of patients. The etiology of these effects is unknown. Sixty percent to 70% of patients remain underweight after total gastrectomy, the weight loss averaging 25% of preoperative body weight. About two thirds of gastrectomized patients report early satiety, and about 60% do not reach the recommended daily calorie intake. The NTS is a brain stem center involved in the regulation of food intake; thus, the extent and pattern of neuronal activation provide information on the process involved in the initiation of satiation and the regulation of food intake. MethodsThe authors investigated neuronal activation in the NTS using c-fos immunohistochemistry following CCK injection or food intake in healthy control rats, sham-operated control rats, age-matched control rats, weight-matched control rats, and vagotomized or gastrectomized rats. ResultsNeuronal activation in the NTS after CCK injection was significantly decreased 21 days after total gastrectomy, but increased by up to 51% 3 months and by up to 102% 12 months after surgery compared to age-matched unoperated control rats. Neuronal activation in the NTS in response to feeding was markedly increased up to fivefold in gastrectomized rats. This increase was early in onset and sustained, and occurred despite significantly reduced food intake. Administration of MK329, a CCK-A receptor antagonist, significantly reduced the number of postprandially activated neurons in both gastrectomized and control rats. ConclusionsThe early postprandial activation of NTS neurons after total gastrectomy in rats may correspond to early satiety reported by patients, while the sustained activation of NTS neurons after a meal could contribute to a reduced daily calorie intake. These data suggest that a disturbed central regulation of food intake might contribute to early satiety, reduced food intake, and weight loss after total gastrectomy.Total gastrectomy is still a mainstay of gastric cancer treatment.1 It is followed by a variety of symptoms and impairments, commonly referred to as postgastrectomy syndromes.2 One important feature of the postgastrectomy syndromes is a considerable loss of body weight.3,4 The loss averages around 25% of preoperative body weight 4,5 and leaves 60% to 70% of patients permanently below ideal body weight. 3,6 While perioperative weight loss due to catabolic metabolism is generally followed by an anabolic phase 3 to 8 days postoperatively with body weight recovery, 7 this is not the case in gastrectomized patients, where weight loss and underweight frequently cause long-lasting morbidity. 4 -6,8 There is evidence that pancreatic insufficiency, resulting in malabsorption and impaired food utilization, contributes Correspon...

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Section: Regulation Of Food Intake After Total Gastrectomy In Ratsmentioning

confidence: 99%

Total Gastrectomy Severely Alters the Central Regulation of Food Intake in Rats

Zittel¹,

Glatzle²,

Müller³

et al. 2002

Annals of Surgery

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“…However, there is some controversy as to whether the reconstruction o f a pouch is actually needed to achieve this. One o f the objections, raised time and again, which asserts that the creation of a pouch could lead to an unnecessary increase in the risk of an operation already considered dangerous [26,31], has meanwhile been largely refuted, as our own results show also [7,[32][33][34][35][36][37], The additional 15-30 min needed, depend ing on whether the sutures are made by stapler [38,39] or by hand, are o f inferior significance.…”

Section: Discussionmentioning

confidence: 99%

“…which reconstruction can (and must) meet, is the pre vention o f intestinal/bile reflux into the oesophagus. How ever, this objective is also obtainable through reconstruc tion without pouch formation, whether through a long (45 cm and more) jejunum interponate [23,24] or via sim ple oesophago-jejunostomy Y-en-Roux [25,26], The ome ga reconstruction, previously popular due to its simplicity (elevated jejunum loop with Braun's anastomosis) must be avoided at all cost today, because it leads to reflux oeso phagitis in more than 50% o f patients [27] and must there fore be considered as one o f the major causes o f the dreaded 'agastric syndrome' [28], There is also agreement in litera ture on the fact that an increase in weight and a subsequent improvement in the quality o f life depends to a large extent on the ability to ingest food portions of normal size [8, 29,30]; if successful, the above-mentioned metabolic defects are amenable to compensation. However, there is some controversy as to whether the reconstruction o f a pouch is actually needed to achieve this.…”

Section: Discussionmentioning

confidence: 99%

Pouch Reconstruction after Total Gastrectomy

Bittner¹

1996

Dig Surg

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The paper provides a detailed description of the surgical technique employed on 333 patients with total gastrectomy and pouch reconstruction. It further gives a detailed discussion of the results in connection with the pertinent literature. The morbidity of the actual pouch reconstruction is extremely low. Suture insufficiencies were observed in none of the cases. Only 1 patient displayed a stasis syndrome during the later postoperative course. With regard to food intake, weight gain and quality of life, pouch reconstruction provides significant advantages for the patient. Concluding from our experience it ought to be considered the first choice in method, even with elderly patients and patients who have undergone palliative surgery.

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“…These disorders can become a serious disturbance for these patients. To reduce such symptoms, various types of reconstruction have been developed, with each providing major or minor benefits [1][2][3][4]. To date, there is little reliable evidence that jejunal interposition with or without a pouch promotes better patient quality of life [5].…”

Section: Introductionmentioning

confidence: 99%