J.Jpn. Surg. Soc.. 59(6): 972-989, 1958
宿題報告
DIGESTION AND ABSORPTION FOLLOWING GASTROINTESTINAL SURGERY
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Professor of Surgery, Chiba University Komei NAKAYAMA |
I believe that I have established the treatment for the hyponutritional condition in the patients who have undergone various gastrointestinal surgeries : Total gastrcctomy combined with resection of the left lobe of the liver, resection of the tail of the pancreas, splenectomy, and removal of the major part of the transverse colon ; or any combination of gastrectomy and any one or several of the above mentioned organs. The results of our extensive study was obtained by useing dogs as subjects for the numerous types of gastrointestinal resections and duplicating conditions of the patients as close as possible. We had also performed enterostomies at different levels throughout the intestinal tract of the different patients so that we could also check absorption and digestion at the various levels of the intestine.
The absolute hyponutritional condition existed in the dog when their total absorbability rate decreased to 60% or protein absorbability decreased to 40%, and in all of these cases we had a 100% mortality. Most of the gastrointestinal resections which included resection of one or more adjacent digestive organs had lower absorption rate for a long period of time atter surgery and in fact we can say, forever. If these of extensive combined resections received adequate postoperative medical treatment for the hyponutritional state they show much better results and never become a serious problem. We cannot stress too strongly this important fact of adequate postoperative nutritional management because if the patient receives inadequate or no treatment and the total absorbability drops below the 90% level of the protein absorption drops below the 40% level the patient will die.
Considering the absorbability after simple gastrectomy and resection of the small intestine, we found that the most important part is the antrum of the stomach and the upper part of the small intestine as far as postoperative digestion is concerned. We should avoid resecting these parts, if possible, but if this is not possible we will have to resect as little of these parts as possible. From the viewpoint of postoperative digestibility we have made studies of the amount or portion of these organs which we determined is permissable to resect.
We have determined the most suitable type of anastomosis after resection of the different parts of the gastrointestinal tract. These recommendations are all on the basis of the evidence cellected from our tests conducted to determine the daily variations of the postoperative absorbability, postoperative recovery course of absorbability, the tolerance of food and the nutritional value of the food.
The problem of recovery of digestion and absorption has been thoroughly investigated by research and we find that it depends upon the compensation of the rest of the organs much more than the number or amount of organs resected. According to the results of our research in this field, defects of the upper part of the digestive tract requires more compensation than the cases where the lower part of the intestinal tract such as ileum and large bowel were resected. In cases of combined resection it is not as simple and recovery depends largely upon the types and combinations of the resection done.
In order to know the best treatment for the postoperative hyponutritional condition we have studied the caloric requirements of postoperative patients and found that the average caloric requirement is 6 to 10% less than normal. But, in the postoperative patients, we have to give more calories than healthy persons require because the postoperative absorbability is less.
According to the evidence of our research, for example, the patient that has undergone a total gastrectomy combined with resection of the tail of the pancreas and splenectomy requires more food than the ordinary man, and in fact requires 10% above his normal requirements.
If we force the patients to take more food without considering their poor digestion and tolerance to food, their absorbability will be decreased and diarrhea will develop.
According to these facts we have established the optimum amount and types of meals for the patients which have undergone the various gastrointestinal surgeries as well as establishing the preper postoperative medical treatment.
In conclusion : We have proven by our research on both animal and human that those that have undergone simple as well as radical combined resections of the gastrointestinal tract and allied organs develop a postoperative hyponutritional condition. This problem was overcome and complications were controled by the development of adequate nutritional management and proper medical treatment.
(author's abstract)
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