GASTRIC OUTLET OBSTRUCTION POST ACID INGESTION IN PEDIATRICS

Aim: Evaluate clinical pattern, diagnosis, surgical management and outcome of Gastric outlet obstruction in children post accidental ingestion corrosive (sulfuric acid of battery) , also role of continuing public education to reduce and avoid incidence these unfortunate events. Patients & method: prospective study for 20 patients’ children with isolated gastric outlet obstruction post corrosive sulfuric acid ingestion was admitted and operated in Saudi hospital at Hajjah Yemen in period April 2015_April 2021. The study evaluates patients’ demographic data, clinical presentation, diagnosis and management, also included in this study the Comparison proportions between two surgical procedures used for management this patient (group (A) pyloric resection and gastroduodenostomy and group (B) gastrojejunostomy with Braun anastomosis) with P value >0.05 was non-significant. Results: Twenty patients with gastric outlet obstruction (12 boys and 8 girls), (Mean age was 4.5). Main presenting symptom recurrent attacks vomiting and loss of weight. The interval between acid ingestion and presentation ranged from 3_4weeks(mean=3.5weeks). The History, Barium swallow and meal used as diagnostic tool because safe, inexpensive. Surgical procedure included group (A)pyloric resection and gastroduodenostomy (n=10) and group (B) gastrojejunostomy with Braun anastomosis (n=10). Comparison between the two surgical procedures show all safe, less morbid, no mortality and no significant difference in end outcome result follow-up period up 2 years, all patients are symptoms free and gained adequate weight. Conclusion: for patients children post corrosive accident ingestion with gastric outlet obstruction The History, barium swallow and meal used as diagnostic tool. Early surgery between 4_6 weeks by resection or bypass remains the treatment of choice with best result. To prevent these unfortunate events by encourage the Family education about clear labelling of dangerous substances and keeps this substance Far from reaching the kids. Key word: corrosive induce gastric outlet obstruction; pyloric stricture; gastric outlet obstruction in pediatrics

Initial outcomes assessment of Billroth II – Braun anastomosis in laparoscopic distal gastrectomy for cancer

Introduction: Gastric cancer is a common disease in the world, among the leading digestive cancers. Until now, surgery, especially laparoscopic surgery, is the primary radical treatment. In there, reestablishment of the gastrointestinal continuity remains controversial. Patients and Methods: A prospective study on 42 patients who underwent laparoscopic distal gastrectomy with Billroth II – Braun anastomosis from October 2019 to June 2020. Results: The post-gastrectomy syndrome with persistent diarrhea accounted for 9.52%; alkaline gastritis accounted for 4.76%. Patients with Grade 2 according to Clavien - Dindo classification accounted for 14.28%. Most patients were with good surgical results of VISICK I (71.44%). 14.28% was with quite good results (VISICK II) and moderate results accounted for 14.28% (VISICK III). There was no case of persistent medical treatment or reoperation. Conclusions: Billroth II - Braun anastomosis is a good choice in laparoscopic distal gastrectomy for cancer with low rate of complications and mild postoperative symptoms that could be easily controlled with short-term medical treatment. Key word: Billroth II – Braun, gastric cancer, distal gastrectomy. Tóm tắt Đặt vấn đề: Ung thư dạ dày là bệnh lý thường gặp trên thế giới, đứng hàng đầu trong các ung thư tiêu hóa. Hiện nay, điều trị ung thư dạ dày (UTDD) bằng phẫu thuật, đặc biệt phẫu thuật nội soi, là phương pháp điều trị triệt căn hàng đầu. Trong đó, tái lập lưu thông tiêu hóa là vấn đề còn đang thảo luận. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả tiến cứu trên 42 người bệnh (NB) UTDD được cắt bán phần dạ dày phần xa bằng phẫu thuật nội soi (PTNS), tái lập bằng miệng nối bilroth II - Braun từ tháng 10/2019 đến tháng 6/2020 và đánh giá kết quả miệng nối Bilroth II (polyA) - Braun trong tái lập lưu thông tiêu hóa sau cắt bán phần xa dạ dày nội soi do ung thư. Kết quả: Hội chứng sau cắt dạ dày với tiêu chảy kéo dài tỷ lệ 9,52%; viêm dạ dày do kiềm chiếm 4,76%. Các NB có độ 2 theo Clavien - Dindo là 14,28%. Phần lớn BN có kết quả phẫu thuật tốt đạt VISICK I (71,44%). 14,28% đạt kết quả khá (VISICK II) và kết quả trung bình là 14,28% (VISICK III). Không có trường hợp cần dùng thuốc dài ngày hay mổ lại. Kết luận: Miệng nối Bilroth II - Braun là một lựa chọn tốt trong phẫu thuật cắt bán phần xa dạ dày do ung thư với tỷ lệ biến chứng sau mổ thấp và các triệu chứng mắc phải sau phẫu thuật thường nhẹ, có thể dễ dàng kiểm soát bằng điều trị nội khoa ngắn ngày. Từ khóa: Billroth II - Braun, ung thư dạ dày, cắt bán phần dạ dày.

Comparison of Roux-en-Y gastrojejunostomy and Billruth-II with Braun anastomosis for gastric reconstruction following partial gastrectomy

Background and aims: Partial gastrectomy surgeries are conducted frequently due to various reasons but there is no consensus regarding the method of choice for gastrointestinal reconstruction. In this study we aimed to compare billruth II with Braun anastomosis and Roux-en-Y gastrojejunostomy. Materials and methods: This prospective study was conducted on patients presented to surgery clinic at Besat and Taleghani hospital between 2018-2020 who were gastrectomy candidates. Patients undergoing Billruth 2 reconstruction with Braun anastomosis or Roux-en-Y gastrojejunostomy were enrolled in the study. Demographics, operation durative and intraoperative blood loss, early postoperative complications, re-admission within 30 days postoperation, 30-day and 90-day mortality were recorded. at an at least 3-month post-surgery period, patients were followed for late postoperative complications. If necessary, endoscopy was conducted and biopsy was taken. Analysis was performed with SPSS version 22. Results: 84 patients in two 42-patient groups were evaluated. All parameters were the same in two groups except operation duration and intraoperative bleeding (significantly higher in RY group), food residue (significantly higher in RY group) and bile in remnant stomach (significantly higher in B2B group). Conclusion: These two methods of reconstruction are comparable in terms of postoperative complications and mortality rates. Food residue and bile reflux are two determinants which should be kept in mind when choosing the surgery plan by surgeons. Keywords: gastrectomy, reconstruction, Billruth, Braun, Roux en Y anastomosis

Clinical case of intussusception of the jejunum into gastroenteroanastomosis after gastric ­resection

Intussusception is one of the varieties of mixed (strangulation and obturation) mechanical intestinal obstruction. It arises as a result of the introduction of the adducting segment of the intestine into the abducting one. Gastroduodenal intussusception is an extremely rare type of high intestinal obstruction. It most often occurs after surgery on the stomach and much less often in non-operated patients. Intussusception of the jejunum into the stomach can occur soon after surgery, but most often, this complication occurs 515 years after the intervention. This paper describes a case of retrograde intussusception that arose 9 years after the Billroth II gastric resection with Braun anastomosis. This clinical case acquaints specialists with the possibility to encounter this pathology in clinical practice and demonstrates the appropriateness of differential diagnostics in cases with similar clinical symptoms.

Pancreaticoduodenectomy with malrotation following reoperation due to torsion of efferent loop: a case report

Background Malrotation is a congenital anomaly during the development of the embryonic intestine. Although it is generally considered a pediatric surgical condition, it can have significant implications for adult surgery in terms of reconstruction. Case presentation The patient was an 85-year-old man with pancreatic cancer and intestinal malrotation. He underwent pancreaticoduodenectomy with modified Child’s reconstruction. Because the ascending colon and efferent loop twisted easily, we fixed the ascending colon to the abdominal wall. Thereafter, right twist and stenosis of the efferent loop occurred. On the 22nd day after the initial surgery, detorsion and Braun anastomosis were performed for efferent loop fixation. Postoperative oral intake was good, and the patient was discharged from our hospital on the 24th day after the reoperation. Conclusions This is a rare case of pancreaticoduodenectomy with malrotation following reoperation due to a complication after Child’s reconstruction. In similar cases of intestinal malrotation, it is important to consider avoiding coaxial positioning of intestinal parts and an upper abdominal space while selecting a reconstruction method.