Gastric surgery at present

Česká verzia

Authors: J. Šafránek; J. Geiger; V. Veselý; D. Kubačková; D. Šmíd
Authors place of work: Přednosta: prof. MUDr. Vladislav Třeška, DrSc. ; Chirurgická klinika FN, Plzeň
Published in the journal: Prakt. Lék. 2015; 95(6): 249-252
Category: Of different specialties

Summary

Methods:
Retrospective analysis of 146 gastric operations in 2010–2014. Only procedures performed for diseases of the stomach, not oesophagus/cardia, or adjacent organs, were evaluated.

Results:
In this period, we performed 54 gastrectomies, 61 subtotal gastrectomies and BII (large) resections, 31 BI and smaller resections, including 9 laparoscopic.

In the gastrectomy group we recorded mortality of 7.4%. The insufficiency of oesophagojejunal anastomosis has occurred in 3 cases (5.6%), in two cases treated with endoscopic stenting. The insufficiency of duodenal stump has occurred in 4 cases (7.4%). To solve resulting complications relaparotomy was necessary in 8 cases (14.8%), otherwise have been possible complications to manage conservatively.

In the group of large resections, mortality was 6.6%. The insufficiency of duodenal stump has occurred in 4 cases (6.6%), serious postoperative bleeding in one case, as well as colon perforation, and the insufficiency of the anastomosis. Relaparotomy for complications was necessary in 4 cases (6.6%).

There was no mortality in the group of small resection, reoperation was required in 1 case (3.2%) because of dehiscence of the laparotomy.

Discussion:
In the spectrum of operations in the long term the stomach surgery for cancer prevails, in our group 74.7%, followed by resection for ulcer complications 11.6%, gastrointestinal stromal tumour (GIST) 4.8%. Removal of the cancer is indicated mostly gastrectomy. Subtotal resection we provided for localization of the tumour in the distal part of stomach, intestinal type of cancer. Smaller resection is performed as a palliative procedure for cancer, or for other indications. After gastrectomy we performed almost always the stapler oesophagojejunal anastomosis, after resection usually hand sewn anastomosis. Cancer makes up the majority of indications for gastrectomy, other indications make up only about a quarter of cases. The most common surgical complications after gastrectomy/gastric resection remains insufficiency of anastomosis or duodenal stump.

Keywords:
gastrectomy – gastric resection – gastric excision

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