Delayed gastric emptying after gastric surgery
| Autor: | Gerald M. Larson, Marcos F. Bar-Natan, Grady Stephens, Todd Massey |
|---|---|
| Rok vydání: | 1996 |
| Předmět: |
medicine.medical_specialty
Metoclopramide Gastrointestinal Diseases medicine.medical_treatment Gastric motility Gastroenterology Pancreaticoduodenectomy Sepsis Stomach surgery Postoperative Complications Risk Factors Stomach Neoplasms Internal medicine medicine Humans Stomach Ulcer Retrospective Studies Gastric emptying business.industry fungi Stomach General Medicine medicine.disease Surgery Gastric Emptying Duodenal Ulcer Pancreatitis Antiemetics business Complication medicine.drug |
| Zdroj: | American journal of surgery. 172(1) |
| ISSN: | 0002-9610 |
| Popis: | Background The reported incidence of delayed gastric emptying (DGE) after gastric surgery is 5% to 25% and usually is based on operations for peptic ulcer disease. Ongoing improvements in perioperative care, nutritional support, and new prokinetic drugs may have had a beneficial effect on the frequency and course of postoperative DGE. Methods We therefore studied our recent experience with DGE in 416 patients who had gastric surgery for ulcer disease (283), cancer (92), or trauma and other indications (41) between January 1985 and December 1993. DGE was defined as inability to eat a regular diet by postoperative day 10. Results DGE occurred in 99 of 416 patients (24%). In 75 of these 99 patients, a postoperative contributing factor for DGE was identified. These factors were sepsis (32), anastomotic edema and leaks (23), obstruction (4), pancreatitis (3), multiple system organ failure (5), and miscellaneous conditions (8). In 24 patients there was no obvious cause for DGE; these patients recovered with nutritional support and time. Re-operation specifically for gastric stasis was not performed. Among the 99 patients with DGE, 67% were eating by day 21, 92% by 6 weeks, and 100% by 10 weeks. Significant risk factors for DGE were diabetes (55%), malnutrition (44%), and operations for malignancy (38%). The Whipple procedure had the highest incidence of DGE (70%), highly selective vagotomy the lowest (0%), while truncal vagotomy had no significant effect. The response to metoclopramide was 20% and unpredictable. Conclusion DGE continues to affect a considerable number of our patients (24%) after gastric surgery and is particularly common in patients with diabetes, malnutrition, and gastric or pancreatic cancer. However, gastric motility does return in 3 to 6 weeks in most patients and the need for re-operation for gastric stasis is rare. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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