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  • Malignant tumors.
  • Benign tumors.
  • Intractable bleeding.
  • Chronic ulceration and inflammation.

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Absolute

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  • Inability to completely resect primary cancer.
  • Distant metastases.

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Relative

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  • High operative risk because of age or comorbidities.

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  • The patient should be supine, with the operating surgeon on the right side of the patient.
  • An upper midline incision is made from the xiphoid to the umbilicus to enter the abdomen.
    • Reverse Trendelenburg positioning facilitates exposure.
  • Once the abdomen has been entered, a routine exploration should be performed and a nasogastric tube placed by the anesthetist.

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  • Nothing by mouth.
  • Monitoring for return of bowel function.
  • Early nutritional support.
    • Parenteral or jejunal feedings are not routinely necessary but may be considered for delayed bowel function or delayed emptying.
    • Postgastrectomy diet (six or more small meals daily, high protein, low carbohydrate, decreased liquids with meals).

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Early

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  • Complications from general anesthesia.
  • Wound infection.
  • Anastomotic leak.
  • Bleeding.
  • Subphrenic or intra-abdominal abscess and peritonitis.
  • Early dumping syndrome.
  • Acute afferent loop syndrome.
  • Rupture of duodenal stump.

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Late

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  • Late dumping syndrome.
  • Obstruction.
  • Marginal ulcer disease (in jejunum no more than 2 cm from gastrojejunal anastomosis).
  • Pernicious anemia (caused by vitamin B12 deficiency).
  • Alkaline reflux gastritis.
  • Chronic afferent and efferent loop syndromes.

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