Truncal Vagotomy, Gastrojejunostomy and Braun Anastomosis Technique in the Surgical Treatment of Intractable Peptic Ulcer

Abstract

Introduction: The present study aims to evaluate the results of bilateral truncal vagotomy (BTV), gastrojejunostomy (GJ) and Braun (B) anastomosis technique, which has been used in our patients with intractable peptic ulcer. Methods: Demographics, indications of surgery (intractability, stenosis, refractory bleeding), diagnostic methods used (barium X-ray, upper gastrointestinal endoscopy), localization of ulcer, early and late postoperative complications, hospitalization period and mortality parameters of 32 patients, who underwent elective surgery (BTV+GJ with long afferent and efferent loops+B) in a two-year period, were retrospectively evaluated in this study. Results: The mean age was 47 years (range, 29-73), and all of them were male (91%) except three patients (9%). The most common localization of ulcers was the first part of the duodenum at anterior wall (64.6%). Resistance to the medical treatment and persistent symptoms (intractability, 34.4%) and pyloric stenosis (31.3%) were the most common indications for surgery. Early postoperative complications were surgical site infections (6.6%), delayed gastric emptying (3.3%) and atelectasis (3.3%). All patients were discharged home between the 5th and 10th postoperative days. Gastric dullness, episodic diarrhea and Dumping syndrome (15.3%, 11.5% and 7.7%, respectively) were among the commonest late postoperative complications in a mean of 20 months follow-up period (range, 12-30). There was no mortality. Discussion and Conclusion: Although ulcer surgery is rarely performed today, after introduction of modern anti-ulcer medications, we think that the BTV+GJ+B procedure can be applied safely in intractable cases.

In silico prediction and in vitro validation of the effect of pH on adhesive behaviour of the fused CsgA-MFP3 protein

“…A steady increase in the pH scale leads to the fact that a DOPA-quinone structure is created through auto-oxidation which cannot form an adhesive bond so that the modified samples on a high pH scale become similar to the unmodified cases. This manner could be seen as a relevant reason for a significantly weaker adhesive force at pH 9–10 for similar chimeric proteins such as CsgA-MFP5 (Zhong et al 2014 ). The result of changes in the fibre diameter could be derived from the SA of the DOPA structure in the modified samples compared to the unmodified without DOPA.…”

“…Molecular dynamic simulations of monomeric and fibrillary arrangements suggested that the amyloid formation of the CsgA core in cooperation with the MFP3 protein does not significantly disrupt the main amyloid structure (Cui et al 2017 ). This finding means that the fused CsgA-MFP3 protein in all analysed samples has an amyloid-like structure relevant for the CsgA domains due to the most noticeable irregularity in MFP3 (due to the exposure to the amyloid core) (Zhong et al 2014 ). But even the statistical evaluation of two of the studies mentioned above does not confirm the hypothesis about the protein surface area at different pH values.…”

“…Previous studies in this area have been fairly advanced by in silico prediction and have been used in particular to measure adhesive force to demonstrate the intrinsic fluorescent activity of such bioadhesive chimeric proteins (Zhong et al 2014 ). In addition, an older study indicates that lysine, threonine, tyrosine (Tyr), and 3,4-dihydroxyphenylalanine (DOPA) occupied 56% of all amino acid contents of similar adhesion proteins (Ohkawa et al 1999 ) but these results refer to the amino acid percentage only as in vitro research.…”

“…Potential applications of mussel-inspired bio-adhesive proteins broadly cover the reconstructive industry, suture replacement (Bal-Ozturk et al 2021 ), new tapes, polymers and medical devices (Saha et al 2020 ), orthopaedics, dentistry and underwater facilities (Palacio et al 2012 ; Quan et al 2019 ). By retaining the chimeric CsgA-MFP3 protein as an abdominal wound covering, surgical examinations such as vagotomy can be avoided (Yıldız et al 2021 ; Roberts and Fitzpatrick. 2013 ).…”