Postgastrectomy and Postvagotomy Syndromes

Transcription

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2 H. D. Becker W.F. Caspary Postgastrectomy and Postvagotomy Syndromes With 84 Figures (Mainly in Two Colors) Springer-Verlag Berlin Heidelberg New York 1980

3 Professor Dr. med. H. D. Becker KlInik und PolIklImk fur Allgemeinchlrurgle, Robert-Koch-Str. 40, D-3400 GottIngen. Federal RepublIc of Germany Professor Dr. med. W. F. Caspary II. MedlzInische Kiinik, Stadtkrankenhaus, LelmenstraBe 20, D-6450 Hanau, Federal RepublIc of Germany ISBN-13: e-isbn-13: DOl: / Library of Congress Cataloging in Publication Data. Becker. Horst-DIeter. 1941, Postgastrectomy and postvagotomy syndromes. Includes bibliographies and Index. 1 Postgastrectomy syndromes. 2. Postvagotomy syndromes. I Caspary, Wolfgang F, 1940, JOInt author. II. TItle. [DNLM: 1. Postgastrectomy syndromes. 2. Vagotomy - Adverse effects 3 Stomach - Surgery WI380 B395p] RD540 5 B45 617: ThIS work IS subject to copynght. All nghts are reserved, whether the whole or part of the matenalls concerned, specifically those of translation, reprinting, re-use of J!lustratlOns, broadcasting, reproduction by photocopylllg machllle or similar means. and storage III data banks Under 54 of the German Copynght Law. where copies are made for other than pnvate use, a fee IS payable to the publisher. the amount ofthe fee to be determined by agreement with the publisher. by Springer-Verlag Berlin Heidelberg 1980 Softcover reprint of the hardcover I st edition 1980 The use of registered names. trademarks. etc. III this publication does not Imply. even III the absence of a specific statement. that such names are exempt from the relevant protective laws and regulations and therefore free for general use. IllustratIOns: Adnan Cornford.

4 To our wifes and children Hedda, Christian, Tina, Brigitte, Ulrike, Martin

5 Foreword Besides the mortality rate the value of an operative procedure is measured against the incidence and the degree of undesirable postoperative sequelae. In the surgical treatment of gastroduodenal ulcerations vagotomy is now competing with the successfully established resection therapy. Since this latter method has been further developed during the last years and late results are rare, a comparison between both types of operation is difficult. Meritoriously, the authors have tried to perform a comprehensive analysis. Due to the complexity of postoperative syndromes the diagnostic procedure and treatment can be successful only after integrated cooperation by gastroenterologists and surgeons. This is documented by the current monograph which originates from a cooperation of several years and an active exchange of scientific and practical experience. The monograph will facilitate the indication for the primary surgical procedure by critical confrontation of the postoperative syndromes and provide advice in treating postoperative complaints. We hope that the monograph will have the expected impact, which means the spreading of the actual knowledge of postgastrectomy and postvagotomy syndromes. W. CREUTZFELDT H. J. PEIPER

6 Contents Part I Gastric Surgery and its Results. 1 1 Short Historical Survey Results of Gastric Surgery Gastric Resection in Peptic Ulcer Disease Truncal Vagotomy plus Drainage in Duodenal Ulcer Patients Comparison of Truncal Vagotomy and Gastric Resection Comparison of Different Drainage Procedures in Vagotomy Comparison of Truncal Vagotomy and Selective Gastric Vagotomy Selective Proximal Vagotomy Comparison of Selective Gastric Vagotomy and Selective Proximal Vagotomy Summary. 16 References.. 16 Part II Diagnostic Procedures 19 3 X-ray Findings.. 19 References Postoperative Endoscopy Gastric Secretory Analysis Pentagastrin Test Gastric Secretion after Billroth I and Billroth II Resection Gastric Secretion after Vagotomy Acid Secretion in Zollinger-Ellison Syndrome Insulin Test Endocrine Provocation Tests Calcium Infusion Test Secretion Test Glucagon Test. 28 References Gastric Emptying Mechanism and Regulation Isotope Tests

7 x 7.3 Gastric Emptying after Gastric Surgery. References Measurement of Reflux..... References Laboratory Tests for Malabsorption 9.1 Absorptive Function Tests Upper Small Intestine Oral Glucose Tolerance Test D-Xylose Test Lactose Tolerance Test Faecal Fat Excretion Breath Tests Small-Bowel Biopsy Ileum Schilling Test C-Glycocholate Breath Test 9.2 Measurement of Enteric Loss of Protein. References Contents Part III Postgastrectomy Syndromes Dumping History and Definition Early Dumping Symptoms Incidence Natural Course Aetiology Medical Treatment Surgical Treatment. 59 References Late Dumping Pathogenesis Therapy.. 71 References Afferent-Loop Syndrome Acute ALS Chronic ALS Therapy Braun's Jejunojejunal Entero-anastomosis Roux-en-Y Anastomosis Conversion of Billroth II to Billroth I Removal of a Simple Gastro-enterostomy Jejunoplasty. 80 References Efferent-Loop Syndrome 81 References

8 Contents XI 13 Postoperative Reflux Gastritis Pathogenesis Differentiation from Chronic Afferent-Loop Syndrome Measurement of Bile Reflux Experimental Results Mechanisms Involved in Gastric Mucosal Damage Lysolecithin - a Pathogenetic Factor? Symptoms and Diagnosis Medical Treatment Surgical Treatment References Postoperative Reflux Oesophagitis Incidence Pathogenesis History and Clinical Symptoms Therapy References Gastro-Ileostomy. 107 References Recurrent Peptic Ulceration Incidence Aetiology Inadequate Surgery Hypersecretion of Acid Ulcerogenic Agents Diagnosis Clinical Symptoms Radiological Examination Gastroscopy Gastric Analysis Conservative Treatment Surgical Therapy Therapy of Gastrojejunocolic Fistula 116 References Gastric Remnant Carcinoma Definition Incidence, Risk and Interval After Operation Pathogenetic Factors Symptoms Diagnostic Procedures Therapy Prognosis References Postgastrectomy Malabsorption Incidence of Weight Loss and Steatorrhoea Physiology of Fat Digestion and Absorption Pathophysiology of Postgastrectomy Steatorrhoea Gastric Mechanism Pancreaticocibal Asynchrasy

9 XII Small-intestinal Factors Bacterial Overgrowth Bacteria and Bile Acid Metabolism Diagnosis Treatment.... References Postgastrectomy Anaemia 19.1 Incidence Iron-Deficiency Anaemia 19.3 Vitamin B12 Deficiency Folate Deficiency... References Postgastrectomy Bone Disease 20.1 Incidence Osteomalacia and Osteoporosis 20.3 Metabolic Findings Diagnosis and Treatment... References Special Aspects of Total Gastrectomy References Part IV Postvagotomy Syndromes Postvagotomy Dysphagia Incidence, Symptoms and Aetiology 22.2 Experimental Findings 22.3 Treatment References Vagal Denervation Syndrome 23.1 Pathophysiology Treatment.... References Postvagotomy Diarrhoea 24.1 Definition and Incidence 24.2 Aetiology Therapy References Cholelithiasis after Vagotomy 25.1 Incidence Pathogenesis..... References Recurrent Ulcer after Vagotomy 26.1 Incidence Pathogenetic Factors Diagnostic Procedure Treatment References. Subject Index... Contents