tipos de gastrectomias, reconstrucciones billroth I y II.

1. Gastrectomías yGastrectomías y
reconstruccionesreconstrucciones
Vargas Flores Edgar R3CG

2. Tipos
• Hemigastrectomía
• Gastrectomía subtotal
• Gastrectomía total
SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004

3. Historia
• 1879 Jules Emile Pean
• 1881 Theodore Billroth
• 1885 Theodore Billroth II
SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004

4. Indicaciones
• Cáncer gástrico
• Enfermedad ulcerosa recurrente
• Úlcera gástrica sangrante
• GIST
FISCHER JE ET AL. MASTERY OF SURGERY. LWW 6TH EDITION. 2011

5. Contraindicaciones relativas
• Anemia
• Hipoproteinemia
• Ascitis
• Carcinomatosis
FISCHER JE ET AL. MASTERY OF SURGERY. LWW 6TH EDITION. 2011

6. Complicaciones intraoperatorias
• Sangrado
• Daño a estructuras adyacentes
– Bazo
– Páncreas
– Hígado
– Vía biliar
FISCHER JE ET AL. MASTERY OF SURGERY. LWW 6TH EDITION. 2011

7. Complicaciones Post operatorias
tempranas
• Sangrado intraluminal
• Fuga anastomótica
• Fuga de muñón duodenal
FISCHER JE ET AL. MASTERY OF SURGERY. LWW 6TH EDITION. 2011

8. Complicaciones Post operatorias
tardías
• Síndrome de vaciamiento gástrico rápido
• Desnutrición
• Obstrucción
• Ulceración de anastomosis
FISCHER JE ET AL. MASTERY OF SURGERY. LWW 6TH EDITION. 2011

9. SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004

10. SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004

11. Gastrectomía con Billroth II

12. Puntos a favor y en contra del B II
• Permite mayor resección de estómago
• Facilita la linfadenectomía
• Tiene menor tensión
• Provoca síntomas de vaciamiento gástrico
rápido
• Tiene menor tasa de reflujo biliar
FISCHER JE ET AL. MASTERY OF SURGERY. LWW 6TH EDITION. 2011

13. DELANEY CP ET AL. NETTER’S SURGICAL ANATOMY AND APPROACHES. SAUNDERS 1 HAR/PSC EDITION. 2013

14. YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012

15. Ligadura de la arteria gàstrica derecha
YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012

16. Liberación del bulbo duodenal, sección y cierre
YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012

17. YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012

18. YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012

21. SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004

22. SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004

23. SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004

24. 1.5x

25. DELANEY CP ET AL. NETTER’S SURGICAL ANATOMY AND APPROACHES. SAUNDERS 1 HAR/PSC EDITION. 2013

26. Gastrectomía con Billroth I

27. DELANEY CP ET AL. NETTER’S SURGICAL ANATOMY AND APPROACHES. SAUNDERS 1 HAR/PSC EDITION. 2013

28. Puntos a favor y en contra del B I
• Mejor absorción del calcio y hierro
• Menor tasa de esteatorrea
• Mejor digestión por enzimas pancreáticas
• Mayor reflujo biliar
• Menor cantidad de cambios histológicos
• Menor incidencia de carcinoma
FISCHER JE ET AL. MASTERY OF SURGERY. LWW 6TH EDITION. 2011

29. Liberación del bulbo duodenal, sección y cierre
YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012

30. YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012

31. YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012

32. YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012

33. YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012

34. YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012

35. SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004

36. Gastrectomía total

37. Indicaciones
• Malignidad gástrica
• Zollinger Ellison
– Acidez no controlada con antisecretores
FISCHER JE ET AL. MASTERY OF SURGERY. LWW 6TH EDITION. 2011

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2
3
3
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DRAKE RL ET AL. GRAY’S ANATOMY FOR STUDENTS. CHURCHILL LIVINGSTONE 3RD EDITION. 2014

39. SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004

40. SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004

41. SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004