The Effect of Longitudinal Gastric Resection in Morbid Obesity Surgery on the Course of Insulin-Dependent Diabetes and Gastroesophageal Reflux Disease

Longitudinal resection of the stomach is a relatively new type of gastroplasty within the framework of bariatric surgery, which is gaining popularity worldwide today not only as a method of getting rid of excess subcutaneous fat, but also from a range of serious chronic diseases together. The potential of longitudinal gastric resection turned out to be promising, and if the first performed longitudinal gastric resection in 1988 was only a restrictive stage of biliopancreotic bypass surgery, then since the 2000s, laparoscopic longitudinal resection has been started as a deliberately first stage in patients with morbid obesity with high operational risk. To date, longitudinal gastric resection has become increasingly used in particularly difficult cases in the form of independent surgical intervention, for example, in the elderly, teenagers, people with cirrhosis of the liver and other severe pathologies. At the initial stages of the formation of this type of treatment, different surgeons did not have a common opinion on many issues related to the technique of this operation. And therefore, to date, the data on the longitudinal resection of the stomach of many years ago are contradictory. They do not create a holistic view of the effectiveness of surgical intervention, especially in the long term. According to IFSO (The International Federation for the Surgery of Obesity and Metabolic Disorders) data, in 2012, longitudinal gastric resection accounted for 27.8% of all bariatric operations, which even then overtook the gastric banding operation in terms of the number of operations. Over the past 20 years, a little more than 250 thousand such operations have been performed worldwide, and the frequency of performing longitudinal gastric resection increases every year. The purpose of this article is to reveal the statistics of the effectiveness of longitudinal gastric resection.

P-P01 Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis

Background Delayed gastric emptying (DGE) is frequent after pancreaticoduodenectomy (PD). Several randomised controlled trials (RCTs) have explored operative strategies to minimise DGE, however, the optimal combination of gastric resection approach, anastomotic route, and configuration, role of Braun enteroenterostomy remains unclear. Methods MEDLINE, Embase, and CENTRAL databases were systematically searched for RCTs comparing gastric resection (Classic Whipple, pylorus-resecting, and pylorus-preserving), anastomotic route (antecolic vs retrocolic) and configuration (Billroth II vs Roux-en-Y), and enteroenterostomy (Braun vs no Braun). A random-effects, Bayesian network meta-analysis with non-informative priors was conducted to determine the optimal combination of approaches to PD for minimising DGE. Results Twenty-four RCTs, including 2526 patients and 14 approaches were included. There was some heterogeneity, although inconsistency was low. The overall incidence of DGE was 25.6% (n = 647). Pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy was associated with the lowest rates of DGE and ranked the best in 35% of comparisons. Classic Whipple, retrocolic, Billroth II with Braun ranked the worst for DGE in 32% of comparisons. Pairwise meta-analysis of retrocolic vs antecolic route of gastro-jejunostomy found increased risk of DGE with the retrocolic route (OR 2.1, 95% CrI; 0.92 - 4.7). Pairwise meta-analysis of Braun enteroenterostomy found a trend towards lower DGE rates with Braun compared to no Braun (OR 1.9, 95% CrI; 0.92 - 3.9). Having a Braun enteroenterostomy ranked the best in 96% of comparisons. Conclusions Based on existing RCT evidence, a pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy may be associated with the lowest rates of DGE.

Evaluation of anemia as a postoperative risk factor in the evolution of patients with gastric resection for malignancies

Introduction. Gastric cancer remains among the top three digestive diseases with the highest mortality rates in the world. Treatment of gastric cancer is multidisciplinary, gastric resection being essential for the best result. Anemia is one of the most common comorbidities present in patients diagnosed with gastric cancer. Materials and Methods. This is a retrospective analytical study over a period of 6 years (2014-2019). It is based on 114 consecutive gastric resections for cancer performed by a single team using exclusively resection and reconstruction stapling methods. The study aims to investigate a correlation between the presence of preoperative anemia and the incidence of postoperative morbidity and mortality. Results. Preoperative anemia was found in 70% of patients, with about half of these patients presenting with mild anemia. Most postoperative complications were grade I and II according to the Clavien Dindo scale. Anemia was correlated with an increase in infectious complications, anastomotic leaks and secondary peritoneal abscesses, pancreatic complications after multivisceral resection and length of hospital stay. Conclusions. Preoperative anemia is a risk factor that exposes the cancer patient to an increased incidence of life-threatening postoperative complications. In addition, it also extends the length of hospital stay and costs. Therefore, special attention should be paid to the identification and reduction of anemia before extensive gastric surgery in order to obtain the best possible therapeutic result.

The ways to improve the results of the pylorus-preserving gastric resection

Objective. To enhance the results efficacy of the pylorus-preserving gastric resection. Materials and methods. Retrospective estimation of results of the pylorus-preserving gastric resection was conducted while various operative procedures application in 64 patients, ageing 34-75 yrs old. The average age of the patients was (52.5 ± 6.2) yrs old. Results. The patients were divided into two Groups. In Group I (n = 36) the pylorus-preserving gastric resection was performed in accordance to conventional procedure - without identification of infrapyloric arteries and veins as well as vagal branches, innervating pyloric sphincter. In Group II (n = 28) accurate dissection was performed, using special optic technique for preservation of all vascular structures, going to pylorus. Conclusion. The pylorus-preserving gastric resection owes several advantages, because it prevents the postgastrectomy syndrome development.

EYUNOGASTROPLASTICА AS AN EFFECTIVE METHOD FOR PREVENTING FUNCTIONAL DISORDERS AFTER PROXIMAL GASTRIC RESECTION

The analysis of the results of treatment of 97 patients who were operated from surgical diseases of the cardiac stomach. Proximal gastric resection (PRG) was performed using isoperistaltic jejunogastroplasty (modified by Merendino-Dillard) (50 people – group I) and with direct esophagogastroanastomosis (47 people – group II). 12 and 24 months after the operation, an X-ray and endoscopic examination of the upper digestive tract was performed, assessing the severity of functional disorders (nutritional status, body weight deficiency, reflux esophagitis, anastomosis) Results. After 2 years or more, 5.9% of patients ate more than 6 times a day in group I, while in group II, 23.3% (p <0.05). 67.6% of patients in group I and 36.7% in group II returned to their previous (as before the illness) diet – 3-4 times a day (p <0.05). After 24 months or more, in group II, the average weight of patients did not exceed preoperative indicators (95.9 ± 0.25%), while in group I, there was an increase in the average weight of 109.9 ± 0.13%. (p <0.05). The frequency of reflux esophagitis was observed in 8 (9.3%) cases: in group I – in 2 (4.5%) and in group II-in 6 (14.3%) (p <0.05) According to the authors, the PRG with the reconstruction of the digestive tract according to Meredino-Dilard creates optimal conditions for a faster and better recovery of functional parameters and demonstrates how significant and effective the performed surgical treatment is.

To the technique of anastomosis for gastric resection for cancer

In weakened and emaciated gastric cancer patients who have been radically operated on, in the immediate postoperative period, quite often a number of complications are noted. The most common congestion in the cult of the stomach and duodenum - expansion of the stomach stump and stasis of the duodenum.

To the technique of gastric resection for highly located ulcers

Gastric resection in high ulcers can often be difficult. The removal of up to two-thirds of the stomach, according to Finsterer, is undesirable, and the imposition of an anastomosis on the part of the stomach, hidden in the left hypochondrium, seems to be a rather serious intervention.

657 ROUTINE ESOPHAGRAMS FOLLOWING HIATUS HERNIA REPAIR MINIMISES REOPERATIVE MORBIDITY: A MULTICENTER COMPARATIVE COHORT STUDY

Hiatus hernia repairs are common. Early complications such as re-herniation, esophageal obstruction and perforation, although infrequent, incur significant morbidity. Here, we determine whether routine postoperative esophagrams following hiatus hernia repair may expedite the surgical management of these complications, reduce reoperative morbidity, and improve functional outcomes. Methods Analysis of a prospectively-maintained database of 1829 hiatus hernia repairs undertaken in 14 hospitals from 1 January 2000 to 30 September 2020. 1571 (85.9%) patients underwent a postoperative esophagram which was reviewed. An early (&lt;14 days) reoperation was performed in 44 (2.4%) patients. Results Compared to those without an esophagram, patients who received one prior to reoperation (n = 37) had a shorter time to diagnosis (2.4 vs. 3.9 days, p = 0.041) and treatment (2.4 vs. 4.3 days, p = 0.037) of their complications. This was associated with decreased open surgery (10.8% vs. 42.9%, p = 0.034), gastric resection (0.0% vs. 28.6%, p = 0.022), postoperative morbidity (13.5% vs. 85.7%, p &lt; 0.001), ICU admission (16.2% vs. 85.7%, p &lt; 0.001), and length-of-stay (7.3 vs. 18.3 days, p = 0.009). Furthermore, patients who underwent early reoperations for asymptomatic re-herniation had less complications and superior functional outcomes at one-year follow-up than those who needed surgery for symptomatic recurrences later on. Conclusion Postoperative esophagrams decreases the morbidity associated with early and late reoperations following hiatus hernia repair, and should be considered for routine use.