Gastric Substitutes
A total gastrectomy, whilst curing some patients of their disease, leaves many with considerable morbidity. Although these symptoms tend to diminish over time for those patients where the operation turns out to be noncurative, they may be left with proble
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METZGER· F. HARDER· M. VON FLUE
Springer-Verlag Berlin Heidelberg GmbH
J.
METZGER
F. HARDER M. VON FLÜE
Gast ic S stet tes With 119 figures, mostly in color, and 34 tables
,
Springer
Dr. med. J. METZGER Leitender Arzt Kantonsspital Luzem Chirurgische Klinik A 6000 Luzem, Switzerland Prof. Dr. med. F. HARDER Netzibodenstrasse 34 4133 Pratteln, Switzerland Prof. Dr. med. M. VON FLÜE Chefarzt Kantonsspital Luzem Chirurgische Klinik A 6000 Luzem, Switzerland
ISBN 978-3-642-62497-1 Cataloging-in-Publication Data applied for Die Deutsche Bibliothek - CIP-Einheitsaufnahme Metzger, Jürg: Gastric substitutes 1 Jürg Metzger; Felix Harder; Markus von Flüe. Springer-Verlag Berlin Heidelberg GmbH, 2002 ISBN 978-3-642-62497-1 ISBN 978-3-642-55880-1 (eBook) DOI 10.1007/978-3-642-55880-1 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concemed, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other ways and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from SpringerVerlag. Violations are liable for prosecution under the German Copyright Law.
© Springer-Verlag Berlin Heidelberg 2003 Originally published by Springer-Verlag Berlin Heidelberg New York in 2003 Softcover reprint of the hardcover 1st edition 2003
http://www.springer.de The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publisher cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Production: PRO EDIT GmbH, Heidelberg, Germany Cover design: Erich Kirchner, Heidelberg, Germany Typesetting: Detzner Fotosatz, Speyer, Germany SPIN: 10779449 24/3130 So - 5 4 3 2 1 0
Contents
1
Introduction . . . . . . . . . . . . . .
1
2
The Consequences of a Gastrectomy
3
2.1
3
2.2
The Physiology of the Stomach . . . . Postgastrectomy Syndromes: An Overview
4
2.3
Disturbed Gastric Function and Motility
5
2.4
Reduced Reservoir Problems (Small Gastric Remnant) ..
5
2.5
The Loss of Duodenal Route .
5
2.6 2.6.1 2.6.2
Dumping Symptoms . . . . . Incidence and Pathophysiology Early Dumping . . . . . . . . . . Late Dumping . . . . . . . . . . . . A Classification and Scoring System Therapy . . . . . Alkaline Reflux Pathophysiology Diagnosis . . . . Barrett's Oesophagus and Oesophageal Cancer Treatment and Prevention . . Loop Syndromes . . . . . . . The Afferent Loop Syndrome The Efferent Loop Syndrome The Roux-Stasis Syndrome Postvagotomy Diarrhoea . . .
