Surgical management of severe intractable postvagotomy diarrhoea

Abstract

Experience with the surgical management of 23 patients with postvagotomy diarrhoea is outlined. The most common pre-operative abnormalities are rapid gastric emptying (14/23) and fast small bowel transit (23/23). Three patients were found to have steatorrhoea due to organic disease. Peptic ulcer surgery performed at a young age (means = 29 years, range 21-37) appears to be the only identifiable risk factor. The results of medical treatment with bile salt binding agents were disappointing in the long term. In 10 out of 13 patients treated with antiperistaltic segments, the procedure had to be reversed because of episodes of severe postprandial colic, intestinal obstruction and bacterial overgrowth. A good result with relief of the explosive diarrhoea was obtained by the distal onlay reversed ileal graft in six out of seven patients. This procedure creates a passive non-propulsive segment, and has no undesirable sequelae. It should be considered in those patients in whom the diarrhoea is not controlled by conservative measures.

Management of Lactose Intolerance

“…Other medical therapy includes intestinal sedatives, cholestyramine, aluminium hydroxide, and low-fat diet (2,16).…”

Long‐term nutrition alterations after surgery for gastrointestinal cancers

“…Adjuvant medications such as bile salt binding resins, for instance, cholestyramine or colesevelam, have been proven effective in a randomized controlled trial 42 . In extreme cases, surgical intervention with reversed jejunal grafts have been attempted; however, dietary changes and medical intervention have improved significantly over time, limiting the need for surgical therapy 28,43 …”

“…42 In extreme cases, surgical intervention with reversed jejunal grafts have been attempted; however, dietary changes and medical intervention have improved significantly over time, limiting the need for surgical therapy. 28,43 Small intestinal bacterial overgrowth…”

Surgical options to enhance intestinal function in patients with short bowel syndrome

“…Reversed segments of intestine have been employed mostly in patients with postvagotomy diarrhea or dumping syndrome. 8 The exact length of bowel to be reversed is critical: too short a segment may ineffective in slowing peristalsis, while too long a segment may create functional obstruction. Outcomes obtained in experimental and clinical series are somewhat disparate, which may be attributable to various lengths of reversed bowel used.…”