Vo
lu
m
e
5,
M
ar
ch
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
LIFETIME STUDY OF THE INTESTINAL LYMPHATIC SYSTEM AFTER
GASTRECTOMY
Chartaqov К.Ch., Chartaqova Х.Х, Chartaqov А.К.
Andijan State Medical Institute
Annotation:
This scientific study examines the effect of gastrectomy on the lymphatic
system of the small intestine in terms of fat absorption. The authors conducted a lifetime
study of the lymphatic vessels in 34 dogs using the method of biological injection. It was
established that under normal conditions, fat absorption occurs predominantly in the
duodenum and the initial sections of the small intestine. However, after gastrectomy, this
absorption is disrupted and shifts to the terminal sections of the small intestine and, in some
cases, even to the large intestine.
A particularly pronounced displacement of the process was observed after operations
involving the Polya–Reichel gastroenterostomy. Under these conditions, the lymphatic
system of the large intestine acquired the ability to absorb fats — a function that is
uncharacteristic under normal conditions. This indicates the high compensatory and adaptive
capacity of the intestinal lymphatic system in the postoperative period.
Keywords
: gastrectomy, lymphatic vessels, small intestine, fat absorption, biological
injection, chyle (white chylous fluid), Polya–Reichel anastomosis, terminal section,
compensatory mechanisms, absorptive function.
Relevance:
The relevance of this study lies in the fact that gastrectomy, regardless of the
method by which it is performed, primarily affects the condition of the intestinal lymphatic
system. It is well known that the lymphatic system plays an important role in the absorption
and transport of food components. Complications observed after gastrectomy are associated
with disturbances in the motor-evacuatory, secretory, and absorptive functions of the
gastrointestinal tract. Therefore, studying this system is appropriate for identifying the
dependence of certain pathological conditions on the intestinal lymphatic network.
The aim of the study
is to determine the role of the lymphatic vessels of the small intestine
in fat absorption after gastrectomy.
Materials and Methods:
To study fat absorption in the small intestine prior to resection, a
lifetime investigation of the lymphatic system was carried out on 34 dogs using the method
of biological injection. For a more thorough understanding of fat absorption in the lymphatic
system from a clinical perspective, experiments were conducted on 34 dogs: 10 were studied
under normal conditions, and 24 were examined on the 7th, 15th, and 30th days after gastric
surgery. To identify the fat absorption process in the intestine during life, the method of
biological injection was used with preliminary special feeding of the dogs.
Results and Discussion:
Biological injections performed before gastrectomy revealed that
lymphatic vessels in the duodenum and the initial part of the small intestine were most
intensely filled with chyle (fat). The lymphatic vessels of the middle part were weakly
contrasted, and those in the terminal sections were almost not filled and not detected, even at
Vo
lu
m
e
5,
M
ar
ch
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
later stages of feeding. Under normal conditions, in dogs during peak digestion, fat
absorption occurs in the duodenum, the initial, and the middle parts of the small intestine.
Consequently, fat absorption decreases toward the terminal direction and ceases before
reaching the very end of the ileum.
Lifetime examination of the small intestine’s lymphatic system after gastrectomy is of
particular interest in experiments. It provides insight into the absorptive function of the
intestine. In the first 7 days after gastrectomy, no contrast in the lymphatic vessels of the
duodenum and small intestine was observed. Only partial and incomplete filling of the
lymphatic vessels with white chylous fluid occurred in some animals at later stages. Early
signs of fat absorption in the initial days after resection are explained by postoperative
changes in the gastric stump due to damage of the vascular and nervous apparatus during the
removal of part of the stomach. Paralysis of the gastric stump and the entire intestine leads
to prolonged food retention in the stump and delayed evacuation of intestinal contents. This
is exacerbated by gastrointestinal tract edema, which is observed in the early postoperative
days.
By the 15th day after gastrectomy, the absorption process begins to recover. However, the
filling of lymphatic vessels with white chylous fluid occurred in the middle sections of the
serous and subserous lymphatic network and was distinctly observed only in the terminal
loops near the end of the intestine. As distance increased in the terminal direction, the
intensity of chyle filling in intra-organ and extra-organ lymphatic formations increased,
reaching its peak at the loops of the terminal part of the small intestine. Lymphatic vessels of
the duodenum contained no chyle and were not detectable. Only in two dogs at a later stage
of resection (30 days) was weak contrast observed in some large sections of the large
intestine, where rather large subserous and serous lymphatic vessels with a white appearance
were found.
Lymphatic collectors of the cecal mesentery and the lymph nodes of the ileocecal angle were
distinctly contoured. The results of in vivo biological injections of lymphatic vessels show
that gastrectomy significantly disrupts the fat absorption process in the intestine. The
disruption is manifested in the terminal displacement of absorption along the gastrointestinal
tract. This displacement is even more pronounced in dogs where gastrectomy was completed
with Polya–Reichel gastroenterostomy. In these animals, the process continued in the loops
of the terminal part of the small intestine. In some cases, fat absorption did not end in the
small intestine but continued into the cecum and even the ascending colon.
This pronounced displacement during the Polya–Reichel operation accelerated intestinal
transit significantly. Sometimes, due to a large anastomosis corresponding to the size of the
resected stomach, food rapidly entered the intestine and moved quickly in the distal direction.
Under these conditions, the intestinal chyle was not prepared for absorption in the initial or
even middle parts of the small intestine. Along with the absorption displacement, another
interesting fact was discovered during experiments on animals operated on by the Polya–
Reichel method. Under normal conditions, fat absorption ends in the small intestine and
does not contrast in the large intestine during biological injection.
However, in dogs after Polya–Reichel resection, the process of fat absorption continued in
the cecum and sometimes even in the ascending part of the colon. These experiments
Vo
lu
m
e
5,
M
ar
ch
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
revealed additional compensatory and adaptive capabilities of the lymphatic system of the
large intestine, which acquired the ability to absorb fats—something never observed under
normal conditions.
Conclusion:
Thus, under the conditions of pronounced terminal displacement of digestion
after gastrectomy by the Polya–Reichel method, a new function was revealed for the
lymphatic vessels of the large intestine — the ability to absorb fats, which indicates the
significant compensatory and adaptive capabilities of the lymphatic system.
References
1.
Volkov V.G. et al.
Diseases of the Operated Stomach
. Cheboksary, 2001, 1, 2, p. 38.
2.
Krylov N.N.
Quality of Life in Patients with Duodenal Ulcer Disease After Surgical
Treatment
. Abstract of Doctoral Dissertation in Medical Sciences, Moscow, 2001.
3.
Z.G. Shirinov et al.
Surgical Treatment of Diseases of the Operated Stomach
.
Surgery
, 2005, Issue 6, p. 37.
4.
Chartakov K.Ch.
The Effect of Gastrectomy on the Lymphatic System of the Small
Intestine
.
Journal of Theoretical and Clinical Medicine
, 2006.
