- no longer done
--> liver cirrhosis, kidney stones, osteoporosis
- should be converted to Roux-en-Y gastric bypass if encountered
Give this one a try later!
Chronic Gastritis Borchardt's Triad (1904)
, Duodenal Switch Jejunoileal Bypass
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2 of 76
Definition
- 50% of cancer-related deaths in Japan
- risk factors - adenomatous polyps, tobacco, prior gastric surgery,
intestinal metaplasia, atrophic gastritis, pernicious anemia, type A
blood, nitrosamines
- sx - pain unrelieved by eating, weight loss
- 40% in antrum
- dx - EGD
- intestinal-type - older men, Japan; rare in US
- path shows glands
- tx - subtotal gastrectomy (>5 cm margins, 2 cm on duodenum)
- diffuse (linitis plastica) - women, MC type in US
- diffuse lymphatic invasion, no glands
- less favorable prognosis than intestinal-type (5-YS 25%)
- tx - total gastrectomy
D1 vs D2 lymphadenectomy --> D2 is better if pancreas and spleen
are preserved
D3 - no additional benefit...Western surgeons consider D3 to be
distant? equivalent to metastasis?
staging laparoscopy - identifies occult metastatic disease in 23-37%
,of patients thought to have localized disease as assessed by CT
MAGIC - neoadjuvant chemotherapy (ECF)
?neoadjuvant XRT?
adjuvant chemotherapy
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Gastric Cancer Gastric Carcinoid Tumor
Gastric Cancer 5-Year Survival from
Gastric Volvulus National Cancer Database
(based on 2002 TNM Staging)
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3 of 76
Definition
- leak
- MCC - ischemia
- sx - T/HR/RR/WBC, often do not have abd pain
- tx if early - usually not contained --> emergent re-op
- tx if late - usually contained --> perc drain, ABx
- marginal ulcers (on jejunum) - 10% --> PPI
- stenosis - serial dilatations
- dilation of excluded stomach
- p/w hiccups
- AXR - large stomach bubble
- tx - g-tube
, - SBO = surgical emergency
- high risk of small bowel herniation, strangulation, infarction,
subsequent necrosis --> emergent OR
Give this one a try later!
Duodenal Ulcer Treatment for Peptic Ulcer Disease Surgical
Obstruction Indications
Roux-en-Y Gastric Bypass Duodenal Ulcer Treatment for
Post-op Complications Perforation
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4 of 76
Definition
- modification of BPD to help lessen the high incidence
of marginal ulcers
entire alimentary tract= 250 cm
common channel= 100 cm
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