The intestinal response to surgery the effect of operation upon the intestinal handling of water and electrolytes

Bunch, G. A.

doi:10.1002/bjs.1800581011

Cited by 3 publications

(1 citation statement)

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“…The 'intraluminal nutrition' hypothesis has been advanced by Dowling and Booth (1967), who suggested that the morphology of the villi is influenced by the chyme. Similarly, it has been assumed that the increase in size of the villi occurring in the efferent loop after gastrectomy is related to the dumping effect of hypertonic mixtures rapidly reaching the upper small intestine (Baird and Dodge, 1957;Jones and Williams, 1963;Johnstone and Adams, 1964;Scott et al, 1964;Bunch, 1971).…”

Section: Discussionmentioning

confidence: 99%

Intestinal changes after jejuno-ileal shunt in obesity: A report of 2 cases

Grenierj

Dauchel

Marescaux

et al. 1977

Journal of British Surgery

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Two cases of end-to-end and end-to-side jejuno-ileal bypass for the treatment of obesity are reported in which both patients underwent reoperation 17 and 23 months later respectively. Macroscopic examination and measurements of length of the various segments of the small intestine have been performed twice in each patient: at the time of the bypass and at the second surgical procedure. In one patient a histological study of both the excluded and functioning small intestine was carried out at the time of each surgical procedure. The functioning intestine had increased in size while the excluded segment had become narrowed. The height of the villi had increased slightly in the functioning ileum and more so in the functioning jejunum compared with the preoperative measurements. In contrast, the height of the villi was moderately reduced in both the bypassed jejunal and ileal segments. These findings confirm the results of experimental studies in animals.

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Section: Discussionmentioning

confidence: 99%

Intestinal changes after jejuno-ileal shunt in obesity: A report of 2 cases

Grenierj

Dauchel

Marescaux

et al. 1977

Journal of British Surgery

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The effects of vagotomy on the intestinal handling of water and electrolytes

Bunch¹,

Shields²

1973

Gut

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SUMMARY A technique of intestinal perfusion has been used to investigate the effects of vagotomy on the intestinal handling of water and electrolytes. The capacity of the vagotomized jejunum to absorb water and electrolytes was found to be unimpaired, even in patients who had severe postvagotomy diarrhoea.Diarrhoea is well recognized as a cause of morbidity after the operation of vagotomy and gastric drainage for duodenal ulceration. Diarrhoea may be said to represent the malabsorption ofwater and electrolytes, and in spite of a great deal of investigation the cause ofthis diarrhoea remains unexplained. The possibility that a defect in the ability of the intestine to absorb water and electrolytes may explain this diarrhoea has been investigated, and in this paper we report on the intestinal handling of water and the principal electrolytes-sodium and potassium-immediately after operation when the effects of vagotomy might be expected to be maximal and later, in patients with and without severe postvagotomy diarrhoea. Patients StudiedSuccessful studies were performed upon 25 subjects; nine of these were patients undergoing truncal vagotomy and nine were patients undergoing cholecystectomy. Of these 18 patients, all except one of them were studied twice immediately after operation, first at six hours and again between 24 and 30 hours after operation.Of the nine patients undergoing vagotomy, three were studied on the day before operation and four of the patients undergoing cholecystectomy were also studied on the day before operation. Additional control data were obtained from four healthy volunteer subjects not undergoing surgery; one of these was studied on two occasions, giving a total of 12 control, or contrast studies. These contrast studies are assumed to represent normal absorption before operation.'Please address requests for reprints to Mr G. A. Bunch, The Royal Infirmary, Ifuddersfield.Received for publication 6 December 1972. After the 10th postoperative day, three patients who had had a vagotomy were studied and three patients with severe postvagotomy diarrhoea who passed frequent, watery stools daily were also studied. Technique of StudyPatients were studied using a technique of intestinal perfusion similar to that described by Phillips and Summerskill (1966). The principle of the method is that a segment of small intestine is perfused with a test solution of known composition. At the end of the test segment the perfusate is sampled by aspiration and analysed. From the change occurring in the volume and composition of the test solution during its passage through the test segment, the rate of absorption from the segment can be calculated.A double-lumen tube, suitably modified (Fig.), was passed through the nose until it reached the upper jejunum. The position of the tube was ascertained by radiographic screening. The proximal balloon (C in the figure) was sited just beyond the duodeno-jejunal flexure.The test solution was modified Tyrode's solution containing Na+-149 m-equiv/1, K+-3.3 m-equiv/1, Cl--1...

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