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[Roux-en-Y gastrectomy. A 12 years' experience]
F V Fernandes1, C Reis, L Mascarenhas
1Clínica Universitária de Cirurgia I, HSM, FML, Lisboa.
Acta Medica Portuguesa
|September 1, 1990
Summary
Roux-en-Y gastrectomy with vagotomy effectively treats post-gastrectomy syndromes and resistant peptic ulcers. While initial gastric emptying issues resolve, long-term symptom-measurement discrepancies can occur in patients.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Clinical Nutrition
Context:
- Review of 161 patients undergoing Roux-en-Y biliary diversion and truncal vagotomy (1978-1989).
- Treatment for post-gastrectomy syndromes (46 patients) and refractory esophago-duodeno-gastric peptic disease (115 patients).
- Focus on clinical and functional outcomes using gastric emptying (GE) studies.
Purpose:
- Evaluate the efficacy and safety of Roux-en-Y gastrectomy with vagotomy.
- Identify critical technical aspects to prevent post-Roux-en-Y Syndrome, particularly gastroparesis and gastric retention.
- Assess long-term clinical outcomes and correlate with functional GE studies.
Summary:
- Overall operative mortality was 2.5%, with 5 reoperations for vagotomy completion, gastric retention, or jejunal stricture.
- 82.9% of patients achieved good (Visick I or II) outcomes at 7.4 years post-surgery.
- Initial post-operative gastric fullness normalized, with most patients showing rapid GE after 6 months; late discrepancies between symptoms and GE were noted.
Impact:
- Roux-en-Y gastrectomy successfully resolved post-gastrectomy syndromes in 80% of cases.
- This procedure is advantageous for medically resistant ulcerative peptic disease in patients under 50.
- Highlights the importance of technical precision to mitigate complications like gastroparesis.