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Bo Eriksson - One of the best experts on this subject based on the ideXlab platform.
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six year results of a prospective randomized trial of selective proximal vagotomy with and without Pyloroplasty in the treatment of duodenal pyloric and prepyloric ulcers
Annals of Surgery, 1993Co-Authors: Sverre Emas, Gorgi Grupcev, Bo ErikssonAbstract:In a consecutive series of patients with uncomplicated prepyloric, pyloric, or duodenal ulcer, 39 patients were randomly allocated to selective proximal vagotomy with Pyloroplasty, and 40 patients to selective proximal vagotomy alone with no operative mortality. Before surgery, all patients had undergone H2-receptor antagonist treatment. No patient was lost for follow-up. At an average follow-up of 6 years, recurrent ulcer was recorded in 15% and 20%, respectively, after selective proximal vagotomy with and without Pyloroplasty. Three of 14 recurrent ulcers were asymptomatic. Epigastric pain with or without ulcer was significantly less common after selective proximal vagotomy with (13%) than without Pyloroplasty (40%). Mild diarrhea or mild dumping was recorded in a few patients. The overall results were very good or good (Visick I or II) in 77% and 55% (significant difference) after vagotomy with and without Pyloroplasty, respectively, and in 82% and 58%, if asymptomatic ulcers were graded as Visick I or II results. Of the 27 patients with Visick III or IV results, three patients needed no treatment (asymptomatic ulcers), and 10 patients had no symptoms during medical treatment. Two patients with vagotomy and Pyloroplasty and nine with vagotomy alone were reoperated. There were no deaths, and the results were graded as Visick I or II in 10 patients and as Visick III in one patient. The authors conclude that selective proximal vagotomy with Pyloroplasty is superior to vagotomy alone for the treatment of prepyloric-pyloric and duodenal ulcer. Recurrent ulcer after vagotomy has a benign course and responds well to ranitidine treatment.
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twelve year follow up of a prospective randomized trial of selective vagotomy with Pyloroplasty and selective proximal vagotomy with and without Pyloroplasty for the treatment of duodenal pyloric and prepyloric ulcers
American Journal of Surgery, 1992Co-Authors: Sverre Emas, Bo ErikssonAbstract:Between 1973 and 1981, 161 patients with prepyloric, pyloric, or duodenal ulcers were randomly allocated to selective vagotomy with Pyloroplasty, selective proximal vagotomy with Pyloroplasty, or selective proximal vagotomy alone. No significant differences in clinical results were found 3 years after surgery by Emas and Fernstrom (Am J Surg 1985; 149: 236–42). There was one postoperative death, and one patient lost to follow-up. Of 159 patients, 52 underwent selective vagotomy with Pyloroplasty, 55 selective proximal vagotomy with Pyloroplasty, and 52 selective proximal vagotomy alone. Fifteen patients did not undergo endoscopy, but they had no epigastric complaints. From 1 to 16 years after surgery, recurrent ulcer was detected in 13%, 18%, and 23%, respectively, after selective vagotomy with Pyloroplasty, selective proximal vagotomy with Pyloroplasty, or selective proximal vagotomy with Pyloroplasty, or selective proximal vagotomy without Pyloroplasty. Twenty-eight percent of the patients with recurrent ulcer had no symptoms and received no treatment. Sixteen patients died within 8 years after surgery of causes unrelated to the ulcer disease. At their final examination, 14 of the 16 patients had Visick I or II (modified Visick scale) results, and the disease that caused their deaths obscured evaluation in 2 patients. The remaining 143 patients were followed up for 8 to 16 years (average: 12 years). Epigastric pain with or without ulcer was recorded more often (significant) after selective proximal vagotomy alone (40%) than after selective vagotomy with Pyloroplasty (17%) or selective proximal vagotomy with Pyloroplasty (14%). Bowel habits were unchanged in 96% of patients who underwent selective vagotomy with Pyloroplasty or selective proximal vagotomy with Pyloroplasty and 100% of patients who had selective proximal vagotomy alone. Mild dumping tended to be more common after vagotomy with Pyloroplasty but was a minor nuisance in only a few patients. Very good or good results (Visick I or II) were recorded in 75% of the patients after selective vagotomy with Pyloroplasty or selective proximal vagotomy with Pyloroplasty and in 54% after selective proximal vagotomy alone (significant difference). Seventeen patients underwent reoperation with antrectomy and gastrojejunostomy Roux-en-Y (13 patients) or gastroduodenostomy (4 patients) with no mortality. The results of the reoperations were graded as Visick I or II results in all but one patient. The final grading, including the reoperations, were Visick I or II in 85% of patients after selective vagotomy with Pyloroplasty and selective proximal vagotomy with Pyloroplasty and in 55% after selective proximal vagotomy alone (significant difference). However, most of the remaining patients with Visick III or IV results needed no treatment (asymptomatic ulcer) or had no symptoms during treatment with antacids or ranitidine. From the overall results after 8 to 16 years of follow-up, we conclude that selective vagotomy with Pyloroplasty and selective proximal vagotomy with Pyloroplasty are superior to selective proximal vagotomy alone for the treatment of prepyloric-pyloric and duodenal ulcers. Ulcers recurring after selective vagotomy or selective proximal vagotomy have a benign course and respond well to H 2 -receptor antagonist treatment.
Sverre Emas - One of the best experts on this subject based on the ideXlab platform.
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six year results of a prospective randomized trial of selective proximal vagotomy with and without Pyloroplasty in the treatment of duodenal pyloric and prepyloric ulcers
Annals of Surgery, 1993Co-Authors: Sverre Emas, Gorgi Grupcev, Bo ErikssonAbstract:In a consecutive series of patients with uncomplicated prepyloric, pyloric, or duodenal ulcer, 39 patients were randomly allocated to selective proximal vagotomy with Pyloroplasty, and 40 patients to selective proximal vagotomy alone with no operative mortality. Before surgery, all patients had undergone H2-receptor antagonist treatment. No patient was lost for follow-up. At an average follow-up of 6 years, recurrent ulcer was recorded in 15% and 20%, respectively, after selective proximal vagotomy with and without Pyloroplasty. Three of 14 recurrent ulcers were asymptomatic. Epigastric pain with or without ulcer was significantly less common after selective proximal vagotomy with (13%) than without Pyloroplasty (40%). Mild diarrhea or mild dumping was recorded in a few patients. The overall results were very good or good (Visick I or II) in 77% and 55% (significant difference) after vagotomy with and without Pyloroplasty, respectively, and in 82% and 58%, if asymptomatic ulcers were graded as Visick I or II results. Of the 27 patients with Visick III or IV results, three patients needed no treatment (asymptomatic ulcers), and 10 patients had no symptoms during medical treatment. Two patients with vagotomy and Pyloroplasty and nine with vagotomy alone were reoperated. There were no deaths, and the results were graded as Visick I or II in 10 patients and as Visick III in one patient. The authors conclude that selective proximal vagotomy with Pyloroplasty is superior to vagotomy alone for the treatment of prepyloric-pyloric and duodenal ulcer. Recurrent ulcer after vagotomy has a benign course and responds well to ranitidine treatment.
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twelve year follow up of a prospective randomized trial of selective vagotomy with Pyloroplasty and selective proximal vagotomy with and without Pyloroplasty for the treatment of duodenal pyloric and prepyloric ulcers
American Journal of Surgery, 1992Co-Authors: Sverre Emas, Bo ErikssonAbstract:Between 1973 and 1981, 161 patients with prepyloric, pyloric, or duodenal ulcers were randomly allocated to selective vagotomy with Pyloroplasty, selective proximal vagotomy with Pyloroplasty, or selective proximal vagotomy alone. No significant differences in clinical results were found 3 years after surgery by Emas and Fernstrom (Am J Surg 1985; 149: 236–42). There was one postoperative death, and one patient lost to follow-up. Of 159 patients, 52 underwent selective vagotomy with Pyloroplasty, 55 selective proximal vagotomy with Pyloroplasty, and 52 selective proximal vagotomy alone. Fifteen patients did not undergo endoscopy, but they had no epigastric complaints. From 1 to 16 years after surgery, recurrent ulcer was detected in 13%, 18%, and 23%, respectively, after selective vagotomy with Pyloroplasty, selective proximal vagotomy with Pyloroplasty, or selective proximal vagotomy with Pyloroplasty, or selective proximal vagotomy without Pyloroplasty. Twenty-eight percent of the patients with recurrent ulcer had no symptoms and received no treatment. Sixteen patients died within 8 years after surgery of causes unrelated to the ulcer disease. At their final examination, 14 of the 16 patients had Visick I or II (modified Visick scale) results, and the disease that caused their deaths obscured evaluation in 2 patients. The remaining 143 patients were followed up for 8 to 16 years (average: 12 years). Epigastric pain with or without ulcer was recorded more often (significant) after selective proximal vagotomy alone (40%) than after selective vagotomy with Pyloroplasty (17%) or selective proximal vagotomy with Pyloroplasty (14%). Bowel habits were unchanged in 96% of patients who underwent selective vagotomy with Pyloroplasty or selective proximal vagotomy with Pyloroplasty and 100% of patients who had selective proximal vagotomy alone. Mild dumping tended to be more common after vagotomy with Pyloroplasty but was a minor nuisance in only a few patients. Very good or good results (Visick I or II) were recorded in 75% of the patients after selective vagotomy with Pyloroplasty or selective proximal vagotomy with Pyloroplasty and in 54% after selective proximal vagotomy alone (significant difference). Seventeen patients underwent reoperation with antrectomy and gastrojejunostomy Roux-en-Y (13 patients) or gastroduodenostomy (4 patients) with no mortality. The results of the reoperations were graded as Visick I or II results in all but one patient. The final grading, including the reoperations, were Visick I or II in 85% of patients after selective vagotomy with Pyloroplasty and selective proximal vagotomy with Pyloroplasty and in 55% after selective proximal vagotomy alone (significant difference). However, most of the remaining patients with Visick III or IV results needed no treatment (asymptomatic ulcer) or had no symptoms during treatment with antacids or ranitidine. From the overall results after 8 to 16 years of follow-up, we conclude that selective vagotomy with Pyloroplasty and selective proximal vagotomy with Pyloroplasty are superior to selective proximal vagotomy alone for the treatment of prepyloric-pyloric and duodenal ulcers. Ulcers recurring after selective vagotomy or selective proximal vagotomy have a benign course and respond well to H 2 -receptor antagonist treatment.
Lee L. Swanstrom - One of the best experts on this subject based on the ideXlab platform.
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hybrid endoluminal stapled Pyloroplasty an alternative treatment option for gastric outlet obstruction syndrome
Surgical Endoscopy and Other Interventional Techniques, 2019Co-Authors: Cristians Gonzalez, Jung Myun Kwak, Federico Davrieux, Ryohei Watanabe, Jacques Marescaux, Lee L. SwanstromAbstract:Background Gastroparesis is a rapidly increasing problem with sometimes devastating consequences. While surgical treatments, particularly laparoscopic Pyloroplasty, have recently gained popularity, they require general anesthesia, advanced skills, and can lead to leaks. Peroral pyloromyotomy is a less invasive alternative; however, this technique is technically demanding and not widely available. We describe a hybrid laparo-endoscopic collaborative approach using a novel gastric access device to allow endoluminal stapled Pyloroplasty as an alternative treatment option for gastric outlet obstruction. Methods Under general anesthesia, six pigs (mean weight 33 kg) underwent endoscopic placement of intragastric ports using a technique similar to percutaneous endoscopic gastrostomy. A 5 mm laparoscope was used for visualization. A functional lumen imagine probe was used to measure the cross-sectional area (CSA) and diameter of the pylorus before, after, and at 1 week after intervention. Pyloroplasty was performed using a 5 mm articulating laparoscopic stapler. Gastrotomies were closed by endoscopic clips, endoscopic suture, or combination. After 6-8 days, a second evaluation was performed. At the end of the protocol, all animals were euthanized. Results Six pyloroplasties were performed. In all cases, this technique was effective in achieving significant pyloric dilatation. The median pre-Pyloroplasty pyloric diameter (D) and cross-sectional area (CSA) were 8 mm (4.9-11.6 mm) and 58.6 mm2 (19-107 mm2), respectively. After the procedure, these values increased to 13.41 mm (9.8-17.6 mm) and 147.7 mm2 (76-244 mm2), respectively (p = 0.0152). No important intraoperative events were observed. Postoperatively, all animals did well, with adequate oral intake and no relevant complications. At follow-up endoscopy, all incisions were healed and the pylorus widely patent. Conclusions Hybrid endoluminal stapled Pyloroplasty is a feasible, safe, and effective alternative method for the treatment of gastric outlet obstruction syndrome.
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laparoscopic Pyloroplasty is a safe and effective first line surgical therapy for refractory gastroparesis
Surgical Endoscopy and Other Interventional Techniques, 2016Co-Authors: Amber L Shada, Christy M. Dunst, Kevin M. Reavis, Radu Pescarus, Emily A Speer, Maria A Cassera, Lee L. SwanstromAbstract:Introduction Surgical options for symptomatic delayed gastric emptying include gastric stimulator implantation, subtotal gastrectomy, and Pyloroplasty. Pyloroplasty has been shown to improve gastric emptying yet is seldom described as a primary treatment for gastroparesis. We present a single-institution experience of laparoscopic Heineke–Mikulicz Pyloroplasty (LP) as treatment for gastroparesis.
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Laparoscopic and Endoscopic Pyloroplasty for Gastroparesis Results in Sustained Symptom Improvement
Journal of Gastrointestinal Surgery, 2011Co-Authors: Michael L Hibbard, Christy M. Dunst, Lee L. SwanstromAbstract:Background Gastroparesis is a chronic digestive disorder with symptoms of nausea, vomiting, bloating, and abdominal pain resulting in a poor quality of life. Surgeons are increasingly asked to treat patients with gastroparesis as medical options have become limited due to safety concerns of many prokinetics. Surgical options include gastric stimulator implantation, sub-total gastrectomy, and Pyloroplasty. We report our experience with minimally invasive Pyloroplasty as sole surgical treatment for adult gastroparesis. Materials and Methods A retrospective review of prospectively collected data of 28 patients who underwent minimally invasive Pyloroplasty alone as treatment for gastroparesis from Jan 2007 to Sept 2010. Pre- and postoperative symptom severity score (SSS), gastric emptying scintigraphy (GES), and medication use were reviewed. Results A laparoscopic Heineke–Mikulicz Pyloroplasty was performed in 26 patients. A laparoscopic assisted, flexible trans-oral endoscopic circular stapled Pyloroplasty was used in two patients. Prokinetic use was significantly reduced from 89% to 14% ( p =
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laparoscopic and endoscopic Pyloroplasty for gastroparesis results in sustained symptom improvement
Journal of Gastrointestinal Surgery, 2011Co-Authors: Michael L Hibbard, Christy M. Dunst, Lee L. SwanstromAbstract:Background Gastroparesis is a chronic digestive disorder with symptoms of nausea, vomiting, bloating, and abdominal pain resulting in a poor quality of life. Surgeons are increasingly asked to treat patients with gastroparesis as medical options have become limited due to safety concerns of many prokinetics. Surgical options include gastric stimulator implantation, sub-total gastrectomy, and Pyloroplasty. We report our experience with minimally invasive Pyloroplasty as sole surgical treatment for adult gastroparesis.
M L Wisbey - One of the best experts on this subject based on the ideXlab platform.
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randomized trial of truncal vagotomy with either Pyloroplasty or pyloric dilatation in the surgical management of chronic duodenal ulcer
British Journal of Surgery, 2005Co-Authors: R Pringle, A D Irving, J N Longrigg, M L WisbeyAbstract:A randomized trial of 41 patients undergoing truncal vagotomy with Pyloroplasty (TV + P) or truncal vagotomy with graded pyloric dilatation (TV + PD) for chronic duodenal ulcer is reported after mean follow-up of 34 months. There was no evidence of gastric stasis in patients who did not have a Pyloroplasty. Liquid gastric emptying studies showed an increased rate of gastric emptying postoperatively in patients both with and without Pyloroplasty. Overall clinical gradings at review were similar in both groups although there were more patients who were completely symptom free in the group with pyloric dilatation accompanying vagotomy.
R Pringle - One of the best experts on this subject based on the ideXlab platform.
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randomized trial of truncal vagotomy with either Pyloroplasty or pyloric dilatation in the surgical management of chronic duodenal ulcer
British Journal of Surgery, 2005Co-Authors: R Pringle, A D Irving, J N Longrigg, M L WisbeyAbstract:A randomized trial of 41 patients undergoing truncal vagotomy with Pyloroplasty (TV + P) or truncal vagotomy with graded pyloric dilatation (TV + PD) for chronic duodenal ulcer is reported after mean follow-up of 34 months. There was no evidence of gastric stasis in patients who did not have a Pyloroplasty. Liquid gastric emptying studies showed an increased rate of gastric emptying postoperatively in patients both with and without Pyloroplasty. Overall clinical gradings at review were similar in both groups although there were more patients who were completely symptom free in the group with pyloric dilatation accompanying vagotomy.
