Izbor rekonstruktivne procedure nakon totalne gastrektomije zbog karcinoma želuca
The choice of reconstructive procedures after total gastrectomy for gastric cancer
Committee membersJeremić, Miroslav
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Stomach cancer is the most common neoplasm of the gastrointestinal tract. Although the incidence of gastric cancer in recent decades been steadily decreasing, it is still the second largest cause of mortality in the world. The survival rate after total gastrectomy for gastric cancer has been improved thanks to early diagnosis and improved operational techniques. After total gastrectomy and systemic lymphadenectomy, many reconstructive techniques have been developed in an effort to minimize the symptoms resulting loss of gastric function, improve physiological and nutritional status of the patient's rapid return to normal daily activities. At the same time, gastric reconstruction method should be technically easy to perform with minimal postoperative complications. Most patients after total gastrectomy develop symptoms postgastrectomy syndrome, dysphagia, heartburn, reflux esophagitis, diarrhea and weight loss. Reduced transit time through the intestine chyme is blamed as the main cause... of malassimilation nutrient nutrients. Nutrient deficiencies may occur as a consequence of disturbed digestion and absorption of protein, fat and liposoluble vitamins that can affect pancreatico-cibal asynchrony and lack of bile acids. Especially notable is the decreased absorption of micronutrients, which are mainly absorbed in the duodenum, such as calcium and iron. The rapid transit of food through the intestine, also reduces the absorption of calcium, while the presence of steatorrhea leads to the formation of insoluble calcium soaps which can contribute calcium malabsorption. After total gastrectomy postgastrektomijska often develop bone disease in the form of osteomalacia or osteoporosis because of lower level of calcium and 25- (OH) vitamin D levels. Iron deficiency, vitamin Bn (cyanocobalamin) deficiency and folic acid deficiency in the postoperative period after total gastrectomy causes the emergence of different forms of anemia. In most patients after total gastrectomy developed excessive bacterial colonization due to lack of stomach „acid barrier,, and chyme stagnation in the afferent jejunum limb, leading to the syndrome of bacterial growth: malabsorption of fats, carbohydrates, protein and micronutrients. Preservation of duodenal passage of food reconstructive procedures should improve the absorption of these nutrients, even in other intestinal segments. Therefore, in order to alleviate the symptoms of postgastrectomy syndromes and improved postoperative quality of life, access to a variety of reconstructive procedures. Since it is relatively simple to perform, it switches the esophagus and jejunum, and may prevent reflux esophagitis, Roux-en-Y reconstruction is the most common reconstructive procedure that is performed after total gastrectomy. However, many researchers have pointed to the importance of the reservoir function of the stomach and duodenum through the passage of food, and the presence of duodenal passage. Therefore, have been developed and reconstructive procedures with preservation of duodenal passage interposition between the esophagus and duodenum, respectively, reconstruction esophagojejunostomy Roux-en-Y configuration „double tract,, isoperistaltic interposition and free jejunal segment by the method of Longmire’s. Quality of life after total gastrectomy is an important fact outcomes postoperative course. Preservation of duodenal passage of reconstruction after total gastrectomy results in better physiological mixture chyme with bile and pancreatic juice, normalization of physiological regulation of gastrointestinal hormones and adequate intestinal motility by down regulating or decrease the incidence of occurrence postgastrectomy syndrome. Reconstruction after total gastrectomy for gastric cancer with duodenal passage preservation of an optimal choice in establishing esophagus-intestinal continuity and improvement of postoperative quality of life of patients.