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Surgical management of severe intractable postvagotomy diarrhoea
Insights
Surgical management for postvagotomy diarrhea, often linked to rapid gastric emptying, showed limited success with antiperistaltic segments. A reversed ileal graft effectively relieved diarrhea in most patients.
Area of Science:
- Gastroenterology
- Surgical Management
- Digestive System Disorders
Background:
- Postvagotomy diarrhea is a debilitating complication following peptic ulcer surgery.
- Common pre-operative findings include rapid gastric emptying and accelerated small bowel transit.
Purpose of the Study:
- To evaluate surgical management strategies for postvagotomy diarrhea.
- To identify risk factors and assess treatment outcomes.
Main Methods:
- Review of 23 patients with postvagotomy diarrhea.
- Assessment of pre-operative abnormalities, including gastric emptying and small bowel transit.
- Evaluation of medical treatments (bile salt binding agents) and surgical interventions (antiperistaltic segments, reversed ileal grafts).
Main Results:
- Rapid gastric emptying (14/23) and fast small bowel transit (23/23) were prevalent.
- Medical treatment with bile salt binding agents yielded disappointing long-term results.
- Antiperistaltic segments required reversal in 10/13 patients due to complications.
- Distal onlay reversed ileal graft provided good relief in 6/7 patients without undesirable sequelae.
Conclusions:
- Peptic ulcer surgery at a young age is an identifiable risk factor.
- The reversed ileal graft is a safe and effective option for refractory postvagotomy diarrhea.
- This procedure should be considered when conservative measures fail.
Abstract:
Experience with the surgical management of 23 patients with postvagotomy diarrhoea is outlined. The most common pre-operative abnormalities are rapid gastric emptying (14/23) and fast small bowel transit (23/23). Three patients were found to have steatorrhoea due to organic disease. Peptic ulcer surgery performed at a young age (means = 29 years, range 21-37) appears to be the only identifiable risk factor. The results of medical treatment with bile salt binding agents were disappointing in the long term. In 10 out of 13 patients treated with antiperistaltic segments, the procedure had to be reversed because of episodes of severe postprandial colic, intestinal obstruction and bacterial overgrowth. A good result with relief of the explosive diarrhoea was obtained by the distal onlay reversed ileal graft in six out of seven patients. This procedure creates a passive non-propulsive segment, and has no undesirable sequelae. It should be considered in those patients in whom the diarrhoea is not controlled by conservative measures.