Gastrojejunal disruptions. Changing concepts in management.

From 1973 through 1983, 197 patients were treated at Harper-Grace Hospital, Detroit, according to a protocol designed to minimize the effects of possible gastrojejunal disruption. All had high-risk resections or bypasses of the stomach reconstructed with an end-to-end Roux-en-Y anastomosis using a long (100-cm) jejunal limb. Eighteen anastomoses leaked, producing fever, pain, and mild respiratory distress in 14 patients and peritonitis with shock in four. Nine of the 14 patients without shock avoided surgery, requiring only antibiotics and nutritional support. The other five had a subphrenic abscess, necessitating drainage. The four patients with shock were treated with staged intestinal discontinuity, nutritional support, and reestablishment of gastrointestinal continuity at a later date. Seventeen patients (94%) survived this serious complication, a significant improvement compared with the mortality of historical controls.

[1]  J. Buckwalter,et al.  Complications of gastric bypass for morbid obesity. , 1980, American journal of surgery.

[2]  C. A. Hardin,et al.  Complications following gastric bypass procedures for morbid obesity. , 1979, Surgery.

[3]  Williamson Jw,et al.  Management of gastroenteric anastomotic disruption. , 1976 .

[4]  E. Mason,et al.  Optimizing Results of Gastric Bypass , 1975, Annals of surgery.

[5]  R. E. Wood,et al.  Improved Management of Esophageal Perforation: Exclusion and Diversion in Continuity , 1974, Annals of surgery.

[6]  B. Ghosh,et al.  Gastrointestinal Suture Line Disruption Following Gastrectomy for Malignant Tumor , 1972, Annals of Surgery.

[7]  F. Ellis,et al.  Analysis of the records of 1,657 patients with carcinoma of the esophagus and cardia of the stomach. , 1970, Surgery, gynecology & obstetrics.

[8]  S. Wallensten,et al.  Leakage at suture lines after partial gastrectomy for peptic ulcer. , 1969, Acta chirurgica Scandinavica.

[9]  D. Wilmore,et al.  Long-term total parenteral nutrition with growth, development, and positive nitrogen balance. , 1968, Surgery.

[10]  J. Hardy,et al.  Complications in Surgery and Their Management , 1969 .

[11]  Maillard Jn,et al.  Fistulas following gastrectomy , 1967 .

[12]  K. Klassen,et al.  Conservative Management of Esophageal Perforation , 1965 .

[13]  R. Foran,et al.  MANAGEMENT OF INTESTINAL FISTULAS. , 1964, American journal of surgery.

[14]  M. D. Turner,et al.  CLINICAL AND EXPERIMENTAL ISCHEMIA OF THE GASTRIC REMNANT. , 1964, Surgery, gynecology & obstetrics.

[15]  Miller Re,et al.  A study of the causes and treatment of external postoperative intestinal fistulas. , 1961 .

[16]  G. M. Williams,et al.  External fistulas arising from the gastro-intestinal tract. , 1960, Annals of surgery.

[17]  B. Carter,et al.  The repair of leaks in the line of anastomosis after the Billroth I gastric resection: an experimental study. , 1957, Annals of Surgery.

[18]  A. Rutter.  Ischaemic necrosis of the stomach following subtotal gastrectomy. , 1953, Lancet.