Skip to main content

Concepts in Surgery of the Stomach and Duodenum

  • Chapter
  • First Online:
Chassin's Operative Strategy in General Surgery

Abstract

The most common indications for gastric operation are morbid obesity, neoplasm, gastrostomy tube placement, and ulcer disease. This chapter discusses important concepts relevant to the choice of operation for these common indications and the management of postoperative complications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Arterburn DE, Olsen MK, Smith VA, et al. Association between bariatric surgery and long term survival. JAMA. 2015;313:62–70.

    Article  CAS  PubMed  Google Scholar 

  • Adams TD, Davidson LE, Litwin SE, et al. Weight and metabolic outcomes 12 years after gastric bypass. NEJM. 2017;377:1143–55.

    Article  PubMed  Google Scholar 

  • Mehaffey JH, LaPar DJ, Clement KC, et al. 10 year outcomes after roux en Y gastric bypass. Ann Surg. 2016;264:121–6.

    Article  PubMed  Google Scholar 

  • Peterli R, Wolnerhanssen BK, Vetter D, et al. Laparoscopic Sleeve Gastrectomy Versus Roux-Y-Gastric Bypass for Morbid Obesity-3-Year Outcomes of the Prospective Randomized Swiss Multicenter Bypass Or Sleeve Study (SM-BOSS). Ann Surg. 2017;265(3):466–73.

    Article  PubMed  Google Scholar 

  • Lazzati A, De Antonio M, Paolino L, et al. Natural History of Adjustable Gastric Banding: Lifespan and Revisional Rate: A Nationwide Study on Administrative Data on 53,000 Patients. Ann Surg. 2017;265(3):439–45.

    Article  PubMed  Google Scholar 

  • Rowland SP; Dharmarajah B; Moore HM, et al: Inferior vena cava filters for prevention of venous thromboembolism in obese patients undergoing bariatric surgery: a systematic review. [Review] Ann Surg. 2015;261(1):35–45.

    Google Scholar 

  • Bartlett MA; Mauck KF; Daniels PR: Prevention of venous thromboembolism in patients undergoing bariatric surgery. [Review]. Vascul Health Risk Manag. 2015;11:461–77.

    Google Scholar 

  • El-Sayes IA, Frenken M, Weiner RA. Management of leakage and stenosis after sleeve gastrectomy. Surgery. 2017;162(3):652–61.

    Article  PubMed  Google Scholar 

  • Bradley JF 3rd, Ross SW, Christmas AB, et al. Complications of bariatric surgery: the acute care surgeon's experience. Am J Surg. 2015;210(3):456–61.

    Article  PubMed  Google Scholar 

  • Bozzetti F, Marubini E, Bonafanti G, et al. Subtotal versus total gastrectomy for gastric cancer: fi ve-year survival rates in a multicenter randomized Italian trial: Italian gastrointestinal tumor study group. Ann Surg. 1999;230:170–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Roukos D, Schmidt-Mathiesen A, Encke A, et al. Adenocarcinoma of the gastric antrum: does D2 total gastrectomy with splenectomy improve prognosis compared to D1 subtotal gastrectomy? A long term survival analysis with emphasis on Lauren classification. Surg Oncol. 1995;4:323–32.

    Article  CAS  PubMed  Google Scholar 

  • Robertson CS, Chung SCS, Woods SDS, et al. A prospective randomized trial comparing R1 subtotal gastrectomy with R3 total gastrectomy for antral cancer. Ann Surg. 1994;220:176–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lee SS, Chung HY, Kwon OK, Yu W. Long term quality of life after distal subtotal and total gastrectomy—symptom and behavior oriented consequences. Ann Surg. 2016;263(4):738–44.

    Article  PubMed  Google Scholar 

  • Harrison LE, Karpeh MS, Brennan MF. Proximal gastric cancers resected via a transabdominal only approach: results and comparisons to distal adenocarcinoma of the stomach. Ann Surg. 1997;225:678–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Aronow JS, Matthews JB, Garcia-Aguilar J, et al. Isoperistaltic jejunal interposition for intractable postgastrectomy alkaline reflux gastritis. J Am Coll Surg. 1995;180:648.

    Google Scholar 

  • Gertler R, Rosenberg R, Feith M, et al. Pouch vs. no pouch following total gastrectomy: meta-analysis and systematic review. Am J Gastroenterol. 2009;104(11):2838–51.

    Article  PubMed  Google Scholar 

  • Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol. 2005;23(28):7114.

    Article  PubMed  Google Scholar 

  • Degiuli M, De Manzoni G, Di Leo A, et al. Gastric cancer—current status of lymph node dissection. World J Gastroenterol. 2016;22:2875–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group Lancet. 1996;347:995.

    CAS  PubMed  Google Scholar 

  • Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Br J Cancer. 1999;79(9–10):1522.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med. 1999;340:908.

    Article  CAS  PubMed  Google Scholar 

  • Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol. 2004;22(11):2069.

    Article  CAS  PubMed  Google Scholar 

  • Jiang L, Yang KH, Guan QL, et al. Survival and recurrence free benefits with different lymphadenectomy for resectable gastric cancer: a meta-analysis. J Surg Oncol. 2013;107:807.

    Article  PubMed  Google Scholar 

  • El-Sedfy A, Dixon M, Seevaratnam R, et al. Personalized surgery for gastric adenocarcinoma: a meta-analysis of D1 versus D2 lymphadenectomy. Ann Surg Oncol. 2015;22:1820.

    Article  PubMed  Google Scholar 

  • Songun I, Putter H, Kranenbarg EM, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439.

    Article  PubMed  Google Scholar 

  • Mocellin S, McCulloch P, Kazi H, et al. Extent of lymph node dissection for adenocarcinoma of the stomach. Cochrane Database Syst Rev. 2015;

    Google Scholar 

  • Ajani JA, D’Amico TA, Almhanna K, et al. Gastric Cancer, Version 3.2016, NCCN Clinical Practice Guidelines in Oncology. J National Compreh Cancer Network. 2016;14(10):1286–312.

    Google Scholar 

  • Han S, Hsu A, Wassef WY. An update in the endoscopic management of gastric cancer. Curr Opin Gastroenterol. 2016;32(6):492–500.

    Article  CAS  PubMed  Google Scholar 

  • Mezhir JJ, Shah MA, Jacks LM, Brennan MF, Coit DG, Strong VE. Positive peritoneal cytology in patients with gastric cancer: natural history and outcome of 291 patients. Ann Surg Oncol. 2010;17:3173–80.

    Article  PubMed  Google Scholar 

  • Honda M, Hiki N, Kinoshita T, et al. Long-term outcomes of laparoscopic versus open surgery for clinical stage I gastric cancer: the LOC-1 study. Ann Surg. 2016;264:214–22.

    Article  PubMed  Google Scholar 

  • Brenkman HJF, Gisbertz SS, Slaman AE, et al. Postoperative outcomes of minimally invasive gastrectomy versus open gastrectomy during the early introduction of minimally invasive gastrectomy in the netherlands: a population-based Cohort Study. Ann Surg. 2017;266(5):831–8.

    Article  PubMed  Google Scholar 

  • Kingham TP, DeMatteo RP. Multidisciplinary treatment of gastrointestinal stromal tumors. Surg Clin N Am. 2009;89(1):217–33.

    Article  PubMed  Google Scholar 

  • Keung EZ, Raut CP. Management of Gastrointestinal Stromal Tumors. Surg Clin N Am. 2017;97(2):437–52.

    Article  PubMed  Google Scholar 

  • Balachandran VP, DeMatteo RP. Gastrointestinal stromal tumors: who should get imatinib and for how long? Adv Surg. 2014;48:165–83.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ho MY, Blanke CD. Gastrointestinal stromal tumors—disease and treatment update. Gastroenterology. 2011;140:1372–6.

    Article  PubMed  Google Scholar 

  • Xiong H, Wang J, Jia Y, et al. Laparoscopic surgery versus open resection in patients with gastrointestinal stromal tumors: An updated systematic review and meta-analysis. Am J Surg. 2017;214(3):538–46.

    Article  PubMed  Google Scholar 

  • Calam J, Baron JH. ABC of the upper gastrointestinal tract: pathophysiology of duodenal and gastric ulcer and gastric cancer. BMJ. 2001;323(7319):980–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lee CW, Sarosi GA Jr. Emergency ulcer surgery. Surg Clin N Am. 2011;91(5):1001–13.

    Article  PubMed  Google Scholar 

  • Vaduganathan M; Bhatt DL; Cryer BL; et al: Proton-pump inhibitors reduce gastrointestinal events regardless of aspirin dose in patients requiring dual antiplatelet therapy. J Am Colle Cardiol. 2016;67(14):1661–71.

    Google Scholar 

  • Yazbek PB, Trindade AB, Chin CM, Dos Santos JL. Challenges to the treatment and new perspectives for the eradication of helicobacter pylori. Digest Dis Sci. 2015;60(10):2901–12.

    Article  PubMed  Google Scholar 

  • Soreide K, Thorsen K, Harrison EM, et al. Perforated peptic ulcer. Lancet. 2015;386(10000):1288–98.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hasselager RB, Lohse N, Duch P, Moller MH. Risk factors for reintervention after surgery for perforated gastroduodenal ulcer. Br J Surg. 2016;103(12):1676–82.

    Article  CAS  PubMed  Google Scholar 

  • Boey J, Lee NW, Koo J, et al. Immediate definitive surgery for perforated duodenal ulcers: a prospective controlled trial. Ann Surg. 1982;196:338–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ng EK, Lam YH, Sung JJ, et al. Eradication of helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial. Ann Surg. 2000;231(2):153–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wilhelmsen M, Moller MH, Rosenstock S. Surgical complications after open and laparoscopic surgery for perforated peptic ulcer in a nationwide cohort. Br J Surg. 2015;102(4):382–7.

    Article  CAS  PubMed  Google Scholar 

  • Jordan PH, Thornby J. Perforated pyloroduodenal ulcers: long-term results with omental patch closure and parietal cell vagotomy. Ann Surg. 1995;221:479–88.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wang YR, Richter JE, Dempsey DT. Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993 to 2006. Ann Surg. 2010;251(1):51–8.

    Article  PubMed  Google Scholar 

  • Lagoo J, Pappas TN, Perez A. A relic or still relevant: the narrowing role for vagotomy in the treatment of peptic ulcer disease. Am J Surg. 2014;207(1):120–6.

    Article  PubMed  Google Scholar 

  • Harbison SP, Dempsey DT. Peptic ulcer disease. Curr Probl Surg. 2005;42(6):346–454.

    Article  PubMed  Google Scholar 

  • Vaezi MF, Yang Y-X, Howden CW. Complications of proton pump inhibitor therapy. Gastroenterology. 2017;153:35–48.

    Article  CAS  PubMed  Google Scholar 

  • Cohen F, Valleur P, Serra J, et al. Relationship between gastric acid secretion and the rate of recurrent ulcer after parietal cell vagotomy. Ann Surg. 1993;217:253–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rohss K, Wilder-Smith C, Bokelund-Singh S, et al. Acid control cannot be improved with a modified-release formulation of a proton pump inhibitor compared with twice-daily dosing of the conventional formulation. Dig Dis Sci. 2010;55(12):3423–9.

    Article  PubMed  Google Scholar 

  • Vogel SB, Drane WE, Woodward ER. Clinical and radionuclide evaluation of bile diversion by Braun enteroenterostomy: prevention and treatment of alkaline reflux gastritis: an alternative to Roux-en-Y diversion. Ann Surg. 1994;219:458–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Yusuf TE, Brugge WR. Endoscopic therapy of benign pyloric stenosis and gastric outlet obstruction. Curr Opin Gastroenterol. 2006;22(5):570–3.

    Article  PubMed  Google Scholar 

  • Csendes A, Maluenda F, Braghetto I, et al. Prospective randomized study comparing three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer. Am J Surg. 1993;166(1):45–9.

    Article  CAS  PubMed  Google Scholar 

  • Laine L. Clinical practice upper gastrointestinal bleeding due to a peptic ulcer. New Engl J Med. 2016;374(24):2367–76.

    Article  PubMed  Google Scholar 

  • Calvet X, Vergara M, Brullet E, et al. Addition of a second endoscopic treatment following epinephrine injection improves outcome in high-risk bleeding ulcers. Gastroenterology. 2004;126(2):441–50.

    Article  PubMed  Google Scholar 

  • Schroder VT, Pappas TN, Vaslef SN, et al. Vagotomy/drainage is superior to local oversew in patients who require emergency surgery for bleeding peptic ulcers. Ann Surg. 2014;259(6):1111–8.

    Article  PubMed  Google Scholar 

  • Emas S, Grupcev G, Eriksson B. Ten-year follow-up of a prospective, randomized trial of selective proximal vagotomy with ulcer excision and partial gastrectomy with gastroduodenostomy for treating corporeal gastric ulcer. Am J Surg. 1994;167(6):596–600.

    Article  CAS  PubMed  Google Scholar 

  • Millat B, Fingerhut A, Borie F. Surgical treatment of complicated duodenal ulcers: controlled trials. World J Surg. 2000;24:299–306.

    Article  CAS  PubMed  Google Scholar 

  • Sverden E, Mattsson F, Sonden A, et al. Risk factors for marginal ulcer after gastric bypass surgery for obesity: a population-based cohort study. Ann Surg. 2016;263(4):733–7.

    Article  PubMed  Google Scholar 

  • Mendelson AH, Donowitz M. Catching the zebra: clinical pearls and pitfalls for the successful diagnosis of Zollinger-Ellison syndrome. Digest Dis Sci. 2017;62(9):2258–65.

    Article  PubMed  Google Scholar 

  • Berg P, McCallum R. Dumping syndrome: a review of the current concepts of pathophysiology, diagnosis, and treatment. Digest Dis Sci. 2016;61(1):11–8.

    Article  PubMed  Google Scholar 

  • Miedema BW, Kelly KA. The roux operation for postgastrectomy syndromes. Am J Surg. 1991;161:256–61.

    Article  CAS  PubMed  Google Scholar 

  • Raimes SA, Wheldon EJ, Smirniotis V, Venables CW, Johnston IDA: Postvagotomy diarrhea put into perspective. Lancet. 1986;851–3.

    Google Scholar 

  • Malchow-Moller A; Frederiksen HJ; Sparso BH, et al: Postvagotomy diarrhea. Lancet. 1986;2(8521–22):1465.

    Google Scholar 

  • Davis JL, Ripley RT. Postgastrectomy syndromes and nutritional considerations following gastric surgery. Surg Clin N Am. 2017;97(2):277–93.

    Article  PubMed  Google Scholar 

  • Ritchie Jr WP. Alkaline reflux gastritis: Late results on a controlled trial of diagnosis and treatment. Ann Surg 203:537–544, 1986.

    Google Scholar 

  • Malagelada JR, Phillips SF, Shorter RG, et al. Postoperative reflux gastritis: pathophysiology and long-term outcome after Roux-en-Y diversion. Ann Intern Med 1985;103:178.

    Google Scholar 

  • Schirmer BD. Gastric atony and the roux syndrome. Gastroenterol Clin N Am. 1994;23:327–43.

    Article  CAS  Google Scholar 

  • Forstner-Barthell AW, Murr MM, Nitecki S, et al. Near-total completion gastrectomy for severe postvagotomy gastric stasis: analysis of early and long-term results in 62 patients. J Gastrointest Surg. 1999;3(1):15–21; discussion 21–3.

    Article  CAS  PubMed  Google Scholar 

  • Speicher JE, Thirlby RC, Burggraaf J, Kelly C, Levasseur S. Results of completion gastrectomies in 44 patients with postsurgical gastric atony. J Gastrointest Surg. 2009;13(5):874–80.

    Article  PubMed  Google Scholar 

  • Vogel SB, Woodward ER. The surgical treatment of chronic gastric atony following Roux-Y diversion for alkaline reflux gastritis. Ann Surg. 1989;209:756–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Navas CM, Patel NK, Lacy BE. Gastroparesis: medical and therapeutic advances. Digest Dis Sci. 2017;62(9):2231–40.

    Article  PubMed  Google Scholar 

  • Harju E. Metabolic problems after gastric surgery. Int Surg. 1990;75(1):27–35.

    CAS  PubMed  Google Scholar 

  • Hu Y, Kim HI, Hyung WJ, et al. Vitamin B(12) deficiency after gastrectomy for gastric cancer: an analysis of clinical patterns and risk factors. Ann Surg. 2013;258(6):970–5.

    Article  PubMed  Google Scholar 

  • Ichikawa C, Takiguchi N, Koda K, et al. Early phase metabolic bone disorders after gastrectomy: influence of active vitamin D treatment. Digest Dis Sci. 2002;47(8):1886–90.

    Article  CAS  PubMed  Google Scholar 

  • Ledoux S, Calabrese D, Bogard C, et al. Long-term evolution of nutritional deficiencies after gastric bypass: an assessment according to compliance to medical care. Ann Surg. 2014;259(6):1104–10.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sean P. Harbison .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Harbison, S.P., Dempsey, D.T. (2022). Concepts in Surgery of the Stomach and Duodenum. In: Scott-Conner, C.E.H., Kaiser, A.M., Nguyen, N.T., Sarpel, U., Sugg, S.L. (eds) Chassin's Operative Strategy in General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-81415-1_24

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-81415-1_24

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-81414-4

  • Online ISBN: 978-3-030-81415-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics