• Gastrectomy
• Postoperative bleeding
• Prophylactic increasing blood pressure
• Treatment outcome

• Humans
• Gastrectomy/adverse effects
• Male
• Female
• Retrospective Studies
• Propensity Score
• Postoperative Hemorrhage/prevention & control
• Postoperative Hemorrhage/epidemiology
• Postoperative Hemorrhage/etiology
• Middle Aged
• Aged
• Blood Pressure

• Afferent loop syndrome
• Case report
• Digestive tract radiography
• Endoscopic
• Recurrent fever

• Humans
• Child
• Jejunostomy
• Liver/surgery
• Anastomosis, Roux-en-Y/adverse effects
• Biliary Tract

• duodenal atresia
• gastrojejunostomy
• laparoscopy
• preduodenal portal vein
• situs inversus

• Afferent loop obstruction
• Biopsy forceps
• Case report
• Endoscopic fragmentation
• Phytobezoar
• Undigested food

• Afferent loop syndrome
• Endoscopic ultrasonography
• Enterostomy
• Gastrojejunostomy
• Self expandable metal stent

• Humans
• Afferent Loop Syndrome/diagnostic imaging
• Afferent Loop Syndrome/etiology
• Afferent Loop Syndrome/surgery
• Endoscopy
• Endosonography/methods
• Stents
• Ultrasonography, Interventional

• Afferent loop obstruction
• covered
• endoscopy
• stent dysfunction
• uncovered

Afferent loop (A-loop) obstruction presenting as acute pancreatitis is a rare clinical entity. We report a case of A-loop obstruction that occurred 15 years after Billroth II gastrectomy, leading to acute pancreatitis and accompanied by duodenal perforation and peritonitis. A 63-year-old man complaining of upper abdominal pain, distention, and nausea was referred to our hospital. The patient was previously treated with antibiotics and gastrointestinal decompression at the primary healthcare institute after being diagnosed with acute pancreatitis. However, the symptoms did not improve. Upon inter-hospital transportation, he experienced a period of relief from the pain but soon developed signs of diffuse peritonitis. Laboratory examination showed elevated serum amylase and lipase. A computed tomography scan revealed slight edema of the pancreas, a dilated and fluid-filled bowel loop across the mid-abdomen, and fluid accumulation in the abdominal cavity and pelvis. An emergency laparotomy was conducted, followed by symptomatic treatments. The patient had an uneventful recovery and was discharged in 4 weeks.

• complications
• gastric cancer
• radical gastrectomy
• reoperation
• risk factors

Afferent loop obstruction (ALO) is defined as duodenal or jejunal mechanical obstruction at the proximal anastomosis site of a gastrojejunostomy. With advances in chemotherapy, the incidence of malignant ALO is increasing. Malignant ALO can be complicated by ischemia, gangrenous bowel, pancreatitis, and ascending cholangitis. Moreover, the general condition of patients with recurrent cancer is often poor. Therefore, accurate and rapid diagnosis and minimally invasive treatments are required. However, no review articles on the diagnosis and treatment of malignant ALO have been published. Through literature searching, we reviewed related articles published between 1959 and 2020 in the PubMed database. Herein, we present recent advances in the diagnosis and treatment of malignant ALO and describe future perspectives. Endoscopic transluminal self-expandable metal stent (SEMS) placement is considered the standard treatment for malignant ALO, as this procedure is well established and less invasive. However, with the development of interventional endoscopic ultrasound (EUS) in recent years, the usefulness of EUS-guided gastrojejunostomy has been reported. Moreover, through indirect comparison, this approach has been reported to be superior to transluminal SEMS placement. It is expected that a safer and less invasive treatment method will be established through the continued advancement and innovation of interventional endoscopy techniques.

• Malignant afferent loop obstruction
• Endoscopic self-expandable metal stent placement
• Endoscopic ultrasound guided gastrojejunostomy
• Lumen-apposing metal stent

• Roux limb
• Roux-en-Y
• endoscopic detorsion
• gastric cancer
• torsion

• Afferent loop syndrome
• Case report
• Fluoroscopy
• Nasointestinal tube
• Roux-en-Y

• adenocarcinoma of the esophagogastric junction
• anti-reflux anastomosis
• proximal gastrectomy

• Distal gastrectomy
• Migrating contraction
• Roux-en-Y reconstruction

• Adhesiolysis
• Laparoscopic gastrectomy
• Laparoscopy
• Postoperative adhesions
• Small bowel obstruction

• Afferent loop
• Afferent loop syndrome
• Diagnosis
• Endoscopic treatment
• Gastrectomy with gastrojejunostomy

• gastrointestinal surgery
• pancreas and biliary tract

• Anastomotic obstruction
• Endoscopy
• Jejunojejunostomy
• Magnetic compression anastomosis

• Afferent loop syndrome
• Comparative study
• Laparoscopy
• Pancreaticoduodenectomy
• Postoperative complications

• Afferent Loop Syndrome/surgery
• Aged
• Digestive System Neoplasms/surgery
• Female
• Humans
• Laparoscopy
• Male
• Middle Aged
• Pancreaticoduodenectomy/methods
• Postoperative Complications/surgery
• Reoperation/statistics & numerical data
• Retrospective Studies
• Risk Factors
• Suture Techniques

• Abdominal pain
• Afferent loop syndrome
• Gastrectomy
• Tomography
• Ultrasonography
• X-ray computed

• afferent loop obstruction
• billroth-ii reconstruction
• nasogastric tube
• roux-en-y reconstruction

• Adult
• Afferent Loop Syndrome/therapy
• Aged
• Decompression, Surgical/methods
• Endoscopy, Gastrointestinal/methods
• Follow-Up Studies
• Gastrectomy
• Humans
• Intubation, Gastrointestinal/methods
• Middle Aged
• Natural Orifice Endoscopic Surgery/methods
• Postoperative Complications/therapy
• Retrospective Studies
• Stomach Neoplasms/surgery
• Treatment Outcome

The occurrence of hiatal hernia after total gastrectomy with Roux-en-Y reconstruction is rare. We report the case of a 76-year-old man who presented with dyspnea, vomiting, and fever around 8 days after total gastrectomy with Roux-en-Y reconstruction. Abdominal computed tomography revealed a hiatal hernia containing part of the small intestine in the left thoracic cavity. Emergent reduction and repair of the hiatal hernia were performed later. Operative findings revealed that the Roux limb was incarcerated in the left pleural cavity. Esophagojejunostomy leakage, perforation of the small intestine with transient ischemic change, and pyothorax were also found. Thus, feeding jejunostomy, thoracoscopic decortication, and diversion T-tube esophagostomy were performed. Considering that the main cause of hiatal hernia is blunt dissection with division of the phrenoesophageal membrane, approximating the crus with 1 or 2 figure-8 sutures, according to the size of the defect, to prevent the incidence of hiatal hernia after total gastrectomy may be performed.

• Gastrectomy
• Hernia
• Hiatal
• Stomach neoplasms

• Gastrointestinal tract
• Post-gastrectomy complications
• Stent

• Aged
• Female
• Gastrectomy/adverse effects
• Gastric Outlet Obstruction/etiology
• Gastric Outlet Obstruction/surgery
• Humans
• Male
• Middle Aged
• Postgastrectomy Syndromes/etiology
• Postgastrectomy Syndromes/surgery
• Reoperation
• Self Expandable Metallic Stents/adverse effects
• Treatment Outcome

• Afferent loop obstruction
• Gastric cancer
• Recurrence
• Self-expandable metal stent (SEMS)
• Total gastrectomy

• Afferent loop obstruction
• Enterolith
• Ileus

Afferent loop syndrome is a rare complication of gastric surgery. An obstruction of the afferent limb can present in various ways. A 73-year-old man presented with one day of persistent abdominal pain, gradually radiating to the back. He had a history of total gastrectomy with a Roux-en-Y reconstruction. Abdominal computed tomography scan revealed dilation of the duodenum and small intestine in the left upper quadrant. Exploratory laparotomy showed volvulus of the biliopancreatic limb that caused afferent loop syndrome. In this patient, the 50 cm long limb was the cause of volvulus. It is important to fashion a Roux-limb of appropriate length to prevent this complication.

Afferent loop obstruction is a purely mechanical complication that infrequently occurs following construction of a gastrojejunostomy. The operations most commonly associated with this complication are gastrectomy with Billroth II or Roux-en-Y reconstruction, and pancreaticoduodenectomy with conventional loop or Roux-en-Y reconstruction. Etiology of afferent loop obstruction includes: (1) entrapment, compression and kinking by postoperative adhesions; (2) internal herniation, volvulus and intussusception; (3) stenosis due to ulceration at the gastrojejunostomy site and radiation enteritis of the afferent loop; (4) cancer recurrence; and (5) enteroliths, bezoars and foreign bodies. Acute afferent loop obstruction is associated with complete obstruction of the afferent loop and represents a surgical emergency, whereas chronic afferent loop obstruction is associated with partial obstruction. Abdominal multiple detector computed tomography is the diagnostic study of choice. CT appearance of the obstructed afferent loop consists of a C-shaped, fluid-filled tubular mass located in the midline between the abdominal aorta and the superior mesenteric artery with valvulae conniventes projecting into the lumen. The cornerstone of treatment is surgery. Surgery includes: (1) adhesiolysis and reconstruction for benign causes; and (2) by-pass or excision and reconstruction for malignant causes. However, endoscopic enteral stenting, transhepatic percutaneous enteral stenting and direct percutaneous tube enterostomy have the principal role in management of malignant and radiation-induced obstruction. Nevertheless, considerable limitations exist as a former Roux-en-Y reconstruction limits endoscopic access to the afferent loop and percutaneous approaches for enteral stenting and tube enterostomy have only been reported in the literature as isolated cases.

• Afferent loop
• Obstruction
• Reoperation
• Endoscopy
• Enterostomy

• afferent loop syndrome
• endoscopic treatment
• metal enteral stent
• pancreaticoduodenectomy

• Efferent loop syndrome
• Postgastrectomy syndrome
• Self-expandable metallic stent

• Aged
• Anastomosis, Surgical
• Constriction, Pathologic
• Device Removal
• Endoscopy, Gastrointestinal/instrumentation
• Gastrectomy/adverse effects
• Gastric Bypass/adverse effects
• Gastric Outlet Obstruction/diagnosis
• Gastric Outlet Obstruction/therapy
• Humans
• Male
• Metals
• Prosthesis Design
• Remission Induction
• Stents
• Time Factors
• Treatment Outcome

Reoperations after gastrectomy for gastric cancer are performed for many types of complications. Unexpected reoperations may cause mental, physical, and financial problems for patients. The aim of the present study was to evaluate the causes of reoperations and to develop a strategic decision-making process for these reoperations.

From September 2002 through August 2010, 6,131 patients underwent open conventional gastrectomy operations at Samsung Medical Center. Of these, 129 patients (2.1%) required reoperation because of postoperative complications. We performed a retrospective analysis of the patients using an electronic medical record review. Statistical data were analyzed to compare age, sex, stage, type of gastrectomy, length of operation, size of tumor, and number of lymph node metastasis between patients who had been operated and those who had not.

The variables of age, sex, tumor stage, type of gastrectomy, length of operation, and number of lymph node metastases did not differ between the 2 groups. However, the mean tumor size in the reoperation group was greater than that in the non-reoperation group (5.0±3.7 [standard deviation] versus 4.1±2.9, P=0.007). The leading cause of reoperation was surgical-site infection (n=49, 0.79%). Patients with intra-abdominal bleeding were operated on again in the shortest period after the initial gastrectomy (6.3±4.2 days). Patients with incisional hernia were not reoperated on until after 208.3±81.0 days, the longest postoperative period.

Tumor size was the major variable leading to reoperation after gastrectomy for gastric cancer. The most common complication requiring the reoperation was a surgical site-related complication.

• Gastrectomy
• Postoperative complications
• Reoperation
• Stomach neoplasms

• Acute Disease
• Afferent Loop Syndrome/etiology
• Aged, 80 and over
• Gastrectomy/methods
• Gastroenterostomy
• Humans
• Intestinal Diseases/complications
• Lithiasis/complications
• Male

Afferent loop (A-loop) obstruction is an uncommon postgastrectomy complication following Billroth-II (B-II) or Roux-en-Y reconstruction. Moreover, its development after laparoscopic gastrectomy has not been reported. Here we report 4 cases of A-loop obstructions after laparoscopic distal gastrectomy (LDG) with B-II reconstruction.

Among the 396 patients who underwent LDG with a B-II anastomosis between April 2004 and December 2011, 4 patients had A-loop obstruction. Their data were obtained from a prospectively maintained institutional database and analyzed for outcomes.

Four patients (1.01%) developed A-loop obstruction. All were male, and their median age was 52 years (range, 30 to 73 years). The interval between the initial gastrectomies and the operation for A-loop obstruction ranged from 4 to 540 days (median, 33 days). All 4 patients had symptoms of vomiting and abdominal pain and were diagnosed by abdominal computed tomographic (CT) scan. The causes of the A-loop obstructions were adhesions (2 cases) and internal herniations (2 cases) that were treated with Braun anastomoses and reduction of the herniated small bowels, respectively. All patients recovered following the emergency operations.

A-loop obstruction is a rare but serious complication following laparoscopic and open gastrectomy. It should be considered when a patient complains of continuous abdominal pain and/or vomiting after LDG with B-II reconstruction. Prompt CT scan may play an important role in diagnosis and treatment.

• Afferent loop obstruction
• Billroth-II operation
• Ileus
• Laparoscopy