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Location of Bile and Pancreatic Outlet in Upper Gastrointestinal Reconstruction: Importance in Digestion and Absorption

Location of Bile and Pancreatic Outlet in Upper Gastrointestinal Reconstruction: Importance in... Abstract The nutritional consequences of gastric operations have been recently emphasized, and many4-6,9,15 consider them to be a most important factor in selecting an operation upon the upper gastrointestinal tract. The methods by which these nutritional deficits occur are thought to be related to (a) alterations in various functions of the stomach, (b) loss of absorptive surface of the duodenum and/or jejunum, and (c) interference with digestive processes in the stomach, duodenum, and jejunum. The reconstruction following all gastric operations provides continuity directly (Billroth I principle) or by bypassing some portion of the proximal intestine (Billroth II principle). The former is said to be less likely to alter the nutritional status.4,13,16,22 This study is being presented to report the effect of various bypassing procedures involving the relative positions of the duodenum and the upper jejunum upon digestion and absorption in upper gastrointestinal reconstruction. Preparations were made in dogs in References 1. Baylin, G. J.; Isley, J. K.; Sanders, A. P.; Reeves, R. J.; Ruffin, J. M.; Hymans, J., and Shingleton, W. W.: The Use of Radioactive Isotopes in the Evaluation of Gastrointestinal Function , Am. J. Roentgenol. 78:705, 1957. 2. Borgström, B.; Dahlquist, G. L., and Sjövall, J.: Studies on Intestinal Digestion and Absorption in the Human , J. Clin. Invest. 36:1521, 1957.Crossref 3. Crider, J. O., and Thomas, J. E.: Secretion of Pancreatic Juice After Cutting Extrinsic Nerves , Am. J. Physiol. 141:730, 1944. 4. Everson, T. C.: Experimental Comparison of Protein and Fat Assimilation After Billroth I, Billroth II, and Segmental Types of Subtotal Gastrectomy , Surgery 36:525, 1954. 5. Everson, T. C.: Nutrition Following Total Gastrectomy, with Particular Reference to Fat and Protein Assimilation , Internat. Abstr. Surg. 95:209, 1952 6. Surg. Gynec. & Obst. , (Sept.) 1952. 7. Harkins, H. N.; Schmitz, E. J.; Nyhus, L. M.; Kanar, E. A.; Zech, R. K., and Griffith, C. A.: The Billroth I Gastric Resection: Experimental Studies and Clinical Observations on 291 Cases , Ann. Surg. 140:405, 1954.Crossref 8. Hoffman, M. C.: Radioactive Iodine-Labeled Fat , J. Lab. & Clin. Med. 41:521, 1953. 9. Isley, J. K.; Sanders, A. P.; Sharpe, K.; Baylin, G. J.; Hymans, J. C.; Ruffin, J. M.; Shingleton, W. W., and Wilson, J.: The Use of I-131 Labeled Oleic Acid in the Study of Gastrointestinal Function , Proc. Soc. Exper. Biol. & Med. 94:807, 1957. 10. Javid, H.: Nutrition in Gastric Surgery with Particular Reference to Nitrogen and Fat Assimilation , Surgery 38:641, 1955. 11. Kremen, A. J.; Linner, J. H., and Nelson, C. H.: An Experimental Evaluation of the Nutritional Importance of Proximal and Distal Small Intestine , Ann. Surg. 40:439, 1954. 12. Malm, J. R.; Reemtsma, K., and Barker, H. G.: Comparative Fat and Fatty Acid Intestinal Absorption Test Utilizing Radioiodine Labeling: Results in Normal Subjects , Proc. Soc. Exper. Biol. & Med. 92:471, 1956. 13. McKenna, R. D.; Bourne, R. H., and Matzko, A.: The Use of I-131 Labeled Fat in the Study of Fat Digestion and Absorption in Normal Individuals and in Patients with Diseases of Fat Absorption , Gastroenterology 32:17, 1957. 14. Mac Lean, L. D.; Perry, J. F.; Kelly, W. D.; Mosser, D. G.; Mannick, A., and Wagensteen, O. H.: Nutrition Following Subtotal Gastrectomy of 4 Types (Billroth I and II, Segmental, and Tubular Resections) , Surgery 35:705, 1954. 15. Moser, F. H.; Ellis, F. H., Jr.; Bollman, J. L., and Grindley, J. H.: Fecal Excretion of Fat Following Esophagogastrectomy in Animals , Surg. Gynec. & Obst. 105:332, 1957. 16. Randall, H. T.: Alterations in Gastrointestinal Tract Function Following Surgery , S. Clin. N. America 38:585, 1958. 17. Robins, R. E.; Robertson, R. H., and McIntosh, H. W.: Fecal Fat and Nitrogen Studies in Postgastrectomy Patients: The Relationship of Fat and Nitrogen Excretion to Weight Loss, and a Comparison Between Billroth I and Billroth II Subtotal Gastrectomies , Surgery 41:248, 1957. 18. Ruffin, J. M.; Keever, I. C.; Chears, C., Jr.; Shingleton, W. W.; Baylin, G. J.; Isley, J. K., and Sanders, A. P.: Further Observations on the Use of I-131 Labeled Lipids in the Study of Diseases of the Gastrointestinal Tract , Gastroenterology 34:484, 1958. 19. Shingleton, W. W.; Baylin, G. J.; Isley, J. K.; Sanders, A. P., and Ruffin, J. M.: A Study of Fat Absorption After Gastric Surgery Using I-131 Labeled Fat , Tr. Am. S.A. 74:149, 1956. 20. Shingleton, W. W.; Fawcett, B., and Vetter, J. S.: Pancreatic Secretion and Response to Secretin After Vagotomy and Sympathectomy , S. Forum , 1:155, 1951. 21. Shingleton, W. W.; Isley, J. K.; Floyd, R. D.; Sanders, A. P.; Baylin, G. J.; Postlewait, R. W., and Ruffin, J. M.: Studies on Postgastrectomy Steatorrhea Using Radioactive Triolein and Oleic Acid , Surgery 42:12, 1957. 22. Wells, M. H.; Shingleton, W. W., and Sanders, A. P.: Absorption in Dogs Following Exclusion of Bile and Pancreatic Juice Using I-131 Labeled Fat , Proc. Soc. Exper. Biol. & Med. 90:717, 1955. 23. Wollaeger, E. E.: Disturbances of Gastrointestinal Function Following Partial Gastrectomy , Postgrad. Med. 8:251, 1950. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives Surgery American Medical Association

Location of Bile and Pancreatic Outlet in Upper Gastrointestinal Reconstruction: Importance in Digestion and Absorption

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Publisher
American Medical Association
Copyright
Copyright © 1960 American Medical Association. All Rights Reserved.
ISSN
0096-6908
DOI
10.1001/archsurg.1960.01290220060009
Publisher site
See Article on Publisher Site

Abstract

Abstract The nutritional consequences of gastric operations have been recently emphasized, and many4-6,9,15 consider them to be a most important factor in selecting an operation upon the upper gastrointestinal tract. The methods by which these nutritional deficits occur are thought to be related to (a) alterations in various functions of the stomach, (b) loss of absorptive surface of the duodenum and/or jejunum, and (c) interference with digestive processes in the stomach, duodenum, and jejunum. The reconstruction following all gastric operations provides continuity directly (Billroth I principle) or by bypassing some portion of the proximal intestine (Billroth II principle). The former is said to be less likely to alter the nutritional status.4,13,16,22 This study is being presented to report the effect of various bypassing procedures involving the relative positions of the duodenum and the upper jejunum upon digestion and absorption in upper gastrointestinal reconstruction. Preparations were made in dogs in References 1. Baylin, G. J.; Isley, J. K.; Sanders, A. P.; Reeves, R. J.; Ruffin, J. M.; Hymans, J., and Shingleton, W. W.: The Use of Radioactive Isotopes in the Evaluation of Gastrointestinal Function , Am. J. Roentgenol. 78:705, 1957. 2. Borgström, B.; Dahlquist, G. L., and Sjövall, J.: Studies on Intestinal Digestion and Absorption in the Human , J. Clin. Invest. 36:1521, 1957.Crossref 3. Crider, J. O., and Thomas, J. E.: Secretion of Pancreatic Juice After Cutting Extrinsic Nerves , Am. J. Physiol. 141:730, 1944. 4. Everson, T. C.: Experimental Comparison of Protein and Fat Assimilation After Billroth I, Billroth II, and Segmental Types of Subtotal Gastrectomy , Surgery 36:525, 1954. 5. Everson, T. C.: Nutrition Following Total Gastrectomy, with Particular Reference to Fat and Protein Assimilation , Internat. Abstr. Surg. 95:209, 1952 6. Surg. Gynec. & Obst. , (Sept.) 1952. 7. Harkins, H. N.; Schmitz, E. J.; Nyhus, L. M.; Kanar, E. A.; Zech, R. K., and Griffith, C. A.: The Billroth I Gastric Resection: Experimental Studies and Clinical Observations on 291 Cases , Ann. Surg. 140:405, 1954.Crossref 8. Hoffman, M. C.: Radioactive Iodine-Labeled Fat , J. Lab. & Clin. Med. 41:521, 1953. 9. Isley, J. K.; Sanders, A. P.; Sharpe, K.; Baylin, G. J.; Hymans, J. C.; Ruffin, J. M.; Shingleton, W. W., and Wilson, J.: The Use of I-131 Labeled Oleic Acid in the Study of Gastrointestinal Function , Proc. Soc. Exper. Biol. & Med. 94:807, 1957. 10. Javid, H.: Nutrition in Gastric Surgery with Particular Reference to Nitrogen and Fat Assimilation , Surgery 38:641, 1955. 11. Kremen, A. J.; Linner, J. H., and Nelson, C. H.: An Experimental Evaluation of the Nutritional Importance of Proximal and Distal Small Intestine , Ann. Surg. 40:439, 1954. 12. Malm, J. R.; Reemtsma, K., and Barker, H. G.: Comparative Fat and Fatty Acid Intestinal Absorption Test Utilizing Radioiodine Labeling: Results in Normal Subjects , Proc. Soc. Exper. Biol. & Med. 92:471, 1956. 13. McKenna, R. D.; Bourne, R. H., and Matzko, A.: The Use of I-131 Labeled Fat in the Study of Fat Digestion and Absorption in Normal Individuals and in Patients with Diseases of Fat Absorption , Gastroenterology 32:17, 1957. 14. Mac Lean, L. D.; Perry, J. F.; Kelly, W. D.; Mosser, D. G.; Mannick, A., and Wagensteen, O. H.: Nutrition Following Subtotal Gastrectomy of 4 Types (Billroth I and II, Segmental, and Tubular Resections) , Surgery 35:705, 1954. 15. Moser, F. H.; Ellis, F. H., Jr.; Bollman, J. L., and Grindley, J. H.: Fecal Excretion of Fat Following Esophagogastrectomy in Animals , Surg. Gynec. & Obst. 105:332, 1957. 16. Randall, H. T.: Alterations in Gastrointestinal Tract Function Following Surgery , S. Clin. N. America 38:585, 1958. 17. Robins, R. E.; Robertson, R. H., and McIntosh, H. W.: Fecal Fat and Nitrogen Studies in Postgastrectomy Patients: The Relationship of Fat and Nitrogen Excretion to Weight Loss, and a Comparison Between Billroth I and Billroth II Subtotal Gastrectomies , Surgery 41:248, 1957. 18. Ruffin, J. M.; Keever, I. C.; Chears, C., Jr.; Shingleton, W. W.; Baylin, G. J.; Isley, J. K., and Sanders, A. P.: Further Observations on the Use of I-131 Labeled Lipids in the Study of Diseases of the Gastrointestinal Tract , Gastroenterology 34:484, 1958. 19. Shingleton, W. W.; Baylin, G. J.; Isley, J. K.; Sanders, A. P., and Ruffin, J. M.: A Study of Fat Absorption After Gastric Surgery Using I-131 Labeled Fat , Tr. Am. S.A. 74:149, 1956. 20. Shingleton, W. W.; Fawcett, B., and Vetter, J. S.: Pancreatic Secretion and Response to Secretin After Vagotomy and Sympathectomy , S. Forum , 1:155, 1951. 21. Shingleton, W. W.; Isley, J. K.; Floyd, R. D.; Sanders, A. P.; Baylin, G. J.; Postlewait, R. W., and Ruffin, J. M.: Studies on Postgastrectomy Steatorrhea Using Radioactive Triolein and Oleic Acid , Surgery 42:12, 1957. 22. Wells, M. H.; Shingleton, W. W., and Sanders, A. P.: Absorption in Dogs Following Exclusion of Bile and Pancreatic Juice Using I-131 Labeled Fat , Proc. Soc. Exper. Biol. & Med. 90:717, 1955. 23. Wollaeger, E. E.: Disturbances of Gastrointestinal Function Following Partial Gastrectomy , Postgrad. Med. 8:251, 1950.

Journal

A.M.A. Archives SurgeryAmerican Medical Association

Published: May 1, 1960

References

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