Peptic ulcer of gastrojejunal anastomosis: an undeservedly neglected problem
https://doi.org/10.23946/2500-0764-2023-8-2-87-92
Abstract
Aim. To evaluate the incidence and causes of peptic ulcers of the gastrojejunal anastomosis to develop the corresponding preventive measures.
Materials and Methods. We retrospectively analysed the case histories of the patients with peptic ulcer who have been admitted to our surgical unit during 1981-1996 and 2007-2021. A total of 62 patients with peptic ulcers of the anastomosis who underwent Billroth II resection were examined radiographically, endoscopically, and intraoperatively, including proteolysis and acidity measurements.
Results. While the number of gastric operations has been reduced by 86%, the number of treated peptic anastomotic ulcers decreased by only 20%. The main cause of peptic ulcers was the high acidity and proteolytic activity of the gastric stump. In 22 out of 28 fully examined patients, duodenal ulcer was treated by hemiresection. The incidence of peptic ulcers of gastrojejunal anastomosis in Kemerovo in 2021 was 0.9 per 100,000 population, with 3.7 Billroth II surgeries per 100,000 population. A resection without vagotomy and insufficient acid reduction are the main causes of peptic ulcers of the gastrointestinal anastomosis, especially duodenal ulcers.
Conclusion. A significant decrease in the number of distal resections of the stomach according to Billroth II over the past 25 years is not accompanied by a similar decline in the number of hospitalized patients with peptic ulcers of the gastrojejunal anastomosis.
About the Authors
V. I. Podoluzhnyi
Kemerovo State Medical University
Russian Federation
Russian Federation
Prof. Valery I. Podoluzhnyi, MD, DSc, Professor, Department of Hospital
Surgery
22a, Voroshilovа Street, Kemerovo, 650056
A. B. Startsev
Podgorbunsky Regional Clinical Emergency Hospital
Russian Federation
Russian Federation
Dr. Andrey B. Startsev, MD, PhD, Head
(22, N. Ostrovskogo Street, Kemerovo, 650000
Yu. A. Kokoulina
Kemerovo State Medical University
Russian Federation
Russian Federation
Dr. Yulia A. Kokoulina, MD, Assistant Professor, Department of Hospital Surgery
22a, Voroshilovа Street, Kemerovo, 650056
I. A. Radionov
Kemerovo State Medical University
Russian Federation
Russian Federation
Prof. Igor A. Radionov, MD, DSc, Professor, Department of Hospital Surgery
22a, Voroshilovа Street, Kemerovo, 650056
References
1. Gorshkov VA, Kolesova EB, Nasonova NV. Diffuzionnyy sposob opredeleniya kislotnosti, sopryazhennyy s issledovaniem proteoliza v verkhnikh otdelakh pishchevaritel'nogo trakta. Laboratornoe delo. 1988;9:35-40.
2. Avdeeva MM, Nikitin NA, Prokop ׳ev YeS. Choice of operation method for acute complications of peptic ulcers of gastointestinal anastomosis. Medical newsletter of Vyatka. 2016;1(49):4-8.
3. Pozdniakov AV, Pozdniakova OF, Sotnikova EA. Clinical and radiological features of peptic anastomosis ulcers in zollinger-ellison syndrome. Visualization in medicine. 2022;4(2):19-26.
4. Gorpinich A.B. The experience of operated stomach surgial treatment. Scientific notes of Orel state university. 2015;4:308-310.
5. Chernookov A.I., Karapetyan M.M., Belyh E.N., Gorbunov V.N., Stolyarchuk E.V., Moiseev A.P., Karchevskii E.V. The experience of treatment in bleeding marginal and postvagotomic ulcers patients. Herald of surgical gastroenterology. 2015;1-2:21-29.
6. Lyubivyy ED, Kim VL, Lyudovskikh IV, Evtikhov AV. Treatment of peptic ulcer of gastroenteroanastomosis complicated by ongoing bleeding. Practical observation. Vestnik IKBFU. Natural and medical sciences. 2021;2:84-92.
7. Leonchenko SV, Petyushkin VN, Motin AP, Dyomin AA, Bobotina NA. A clinical case of surgical treatment of peptic ulcer of gastroenteroanastomosis. Science of the young (Eruditio juvenium). 2021;9(1):101-106. https://doi.org/10.23888/HMJ202191101-106
8. Binenbaum SJ, Dressner RM, Borao FJ. Laparoscopic repair of a free perforation of a marginal ulcer after Roux-en-Y gastric bypass: a safe alternative to open exploration. JSLS. 2007;11(3):383-388.
9. Chernookov AI, Badma-Garayev MS, Karapetyan MM, Bagdasarov VV, Bagdasarova EA, Belyh EN, Moiseev AP, Karchevskii EV. The modern approaches in bleeding marginal and postvagotomic ulcers patients tre atment. Herald of surgical gastroenterology. 2013;4:11-19.
10. Nikitin NA, Korshunova ТP, Prokopiev ЕS, Onuchin MA, Avdeeva MM. Surgical treatment for urgent complications of peptic ulcers of gastointestinal anastomosis. Fundamental'nye issledovaniya. 2015;1-6:1199-1203.
11. Wang E, Blackham R, Tan J, Hamdorf J. Giant perforated marginal ulcer after laparoscopic Roux-en-Y gastric bypass. BMJ Case Reports. 2017;2017:bcr-2016-218829. https://doi.org/10.1136/bcr-2016-218829
12. Fringeli Y, Worreth M, Langer I. Gastrojejunal Anastomosis Complications and Their Management after Laparoscopic Roux-en-Y Gastric Bypass. J. Obesity. 2015;2015:698425. https://doi.org/10.1155/2015/698425
13. Steinemann DC, Schiesser M, Clavien PA, Nocito A. Laparoscopic gastric pouch and remnant resection: a novel approach to refractory anastomotic ulcers after Roux-en-Y gastric bypass: case report. BMC Surgery.2011;11:33. https://doi.org/10.1186/1471-2482-11-33
14. Garrido AB Jr, Rossi M, Lima SE Jr, Brenner AS, Gomes CA Jr. Early marginal ulcer following Roux-en-Y gastric bypass under proton pump inhibitor treatment: prospective multicentric study. Arq Gastroenterol. 2010;47(2):130-134. https://doi.org/10.1590/s0004-28032010000200003
15. Gupta A, Shah MM, Kalaskar SN, Kroh M. Late postoperative bleeding after Roux-en-Y gastr ic bypass: management and review of literature. BMJ Case Reports. 2018;11(1):e226271. https://doi.org/10.1136/bcr-2018-226271
16. Sidani S, Akkary E, Bell R. Catastrophic bleeding from a marginal ulcer after gastric bypass. JSLS. 2013;17(1):148-151. https://doi.org/10.4293/108680812x13517013318274
17. Issa H, Al-Saif O, Al-Momen S, Bseiso B, Al-Salem A. Bleeding duodenal ulcer after Roux-en-Y gastric bypass surgery: the value of laparoscopic gastroduodenoscopy. Annals of Saudi Medicine, 2010;30(1):67-69. https://doi.org/10.4103/0256-4947.59382
Review
For citations:
Podoluzhnyi V.I., Startsev A.B., Kokoulina Yu.A., Radionov I.A. Peptic ulcer of gastrojejunal anastomosis: an undeservedly neglected problem. Fundamental and Clinical Medicine. 2023;8(2):87-92. (In Russ.) https://doi.org/10.23946/2500-0764-2023-8-2-87-92
Views:
535
Email this article 