cellulase and Stomach-Neoplasms

Postoperative adhesion is a frequent problem in patients undergoing surgery. In particular, gastrectomy is associated with a high risk of bowel obstruction. However, there are few reports of small bowel obstruction (SBO) after gastrectomy in the English-language literature. We reviewed the literature to assess the effectiveness of various techniques for preventing adhesion in patients treated with gastrectomy. We assumed that strategies used to prevent postoperative adhesion associated with colorectal surgery, cholecystectomy, appendectomy and gynecologic procedures are similar to those used in gastrectomy. We therefore reviewed reports on the prevention of postoperative SBO in any abdominal surgical procedure, focusing especially on gastrectomy. General intraoperative preventive techniques, such as the use of starch-free gloves, saline irrigation at a temperature below 37 °C and laparoscopic techniques whenever possible, may reduce the incidence of SBO in patients with gastric cancer who undergo gastrectomy. If preserving the omentum is unrelated to the survival rate of patients with gastric cancer, this technique should be recommended for preventing postoperative SBO. The use of hyaluronic acid/carboxymethylcellulose bioabsorbable membranes should also be considered in patients undergoing gastrectomy. However, demonstrating the advantages of bioabsorbable membranes would require larger randomized studies with a longer follow-up period.

Topics: Biocompatible Materials; Cellulase; Gastrectomy; Gloves, Surgical; Humans; Hyaluronic Acid; Intestinal Obstruction; Intestine, Small; Intraoperative Care; Laparoscopy; Membranes, Artificial; Omentum; Postoperative Complications; Sodium Chloride; Starch; Stomach Neoplasms; Temperature; Therapeutic Irrigation

Phytobezoar occurring as a complication of gastric carcinoma is reported for the first time. A review of the pathogenesis of phytobezoar suggests that hypomotility and hyposecretion are the two most important factors in bezoar formation. In the case discussed, hypomotility as a consequence of neoplastic involvement of the gastric antrum was the most important precipitating factor. However, documentation of prior hyposecretion was also noted and suggests that a combination of these two factors may be more significant than each taken alone. The therapeutic management of bezoars in patients who are not candidates for surgery is frequently difficult. This is the third case in which the enzyme cellulase has been used successfully for bezoar dissolution.

Topics: Adenocarcinoma, Scirrhous; Aged; Anemia, Pernicious; Bezoars; Biopsy; Cellulase; Female; Gastric Mucosa; Gastrointestinal Motility; Humans; Hypothyroidism; Multiple Myeloma; Radiography; Stomach Neoplasms; Vegetables