J Korean Surg Soc.  2000 Dec;59(6):759-764.

Clinical Study of the Pylorus Preserving Proximal Subtotal Gastrectomy

• Noh SM
• Bae JS
• Jeong HY
• Cho JS
• Shin KS
• Song KS
• So Y

Abstract

PURPOSE: Many clinics have abandoned the use of a proximal subtotal gastrectomy for adenocarcinomas of the stomach because of the poor survival rate, the high incidence of operative complication, and the lack of an advantage saving the antral stump. The authors performed an esophagogastrostomy after a proximal subtotal gastrectomy without pyloroplasty and evaluated the outcome of this pylorus-preserving proximal subtotal gastrectomy. METHODS: After the pylorus-preserving proximal subtotal gastrectomy in 16 patients with a gastric adenocarcinoma, the status of the esophageal and gastric mucosa was evaluated using endoscopy, and the function of the pylorus was estimated using an upper gastrointestinal series. In this clinical study, the data were collected between September 1996 and August 1999 at Chungnam National University Hospital. RESULTS: The function of the pylorus of the stomach was well preserved without any severe reflux from the duodenum. The incidences of esophagitis and gastritis were 11 out of 16 patients and 3 out of 16 patients, respectively, in this operation. Esophageal stricture developed in 5 out of 16 patients. CONCLUSION: The pylorus-preserving proximal subtotal gastrectomy (without conventional pyloroplasty) is effective in terms of preventing postoperative reflux gastritis. The emptying mechanism of the pyloric sphincter and the reservoir function of the stomach were well preserved in this study. We think that the pylorus-preserving proximal subtotal gastrectomy is one of useful methods for early adenocarcinomas of the proximal stomach. However, reflux esophagitis and stricture of the esophagogastrostomy site are common problems to be solved in the future.

Keyword

Adenocarcinoma of the stomach; Esophagogastrostomy; Pylorus preserving proximal subtotal gastrectomy

MeSH Terms

Adenocarcinoma
Chungcheongnam-do
Constriction, Pathologic
Duodenum
Endoscopy
Esophageal Stenosis
Esophagitis
Esophagitis, Peptic
Gastrectomy*
Gastric Mucosa
Gastritis
Humans
Incidence
Pylorus*
Stomach
Survival Rate