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A comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gastrectomy.
Ann Surg. 2008 Jun; 247(6):962-7.AnnS

Abstract

OBJECTIVE

The present study evaluated the efficacy of Roux-en-Y (R-Y) reconstruction and Billroth-I (B-I) reconstruction after laparoscopy-assisted distal gastrectomy (LADG).

PATIENTS AND METHODS

Between October 2000 and February 2006, a total of 133 consecutive patients who underwent LADG for gastric carcinoma were classified into 2 groups according to reconstruction (B-I, n = 65; R-Y, n = 68). Parameters analyzed included patients and tumor characteristics, operative details, postoperative outcomes, and nourishment state. Endoscopic findings of the gastric remnant and lower esophagus were evaluated at 12 months postoperatively.

RESULTS

Regarding postoperative complications, no significant differences were found between groups. In the B-I group, 3 patients developed anastomotic leakage and 4 patients suffered anastomotic stricture requiring endoscopic balloon dilation. So-called functional stasis after R-Y reconstruction was not found in this study. Incidence of heartburn at 12 months postoperatively was 37% in the B-I group and 8% in the R-Y group (P = 0.0002). Amount of meal consumed compared with preoperative value at 12 months postoperatively was significantly higher for the R-Y group than for the B-I group (83.6% +/- 15.3% vs. 77.8% +/- 16.0%; P = 0.047). Endoscopic findings showed that incidence of remnant gastritis was significantly lower in the R-Y group than in the B-I group (12% vs. 34%; P = 0.002). Bile reflux into the remnant stomach was not observed in the R-Y group.

CONCLUSION

R-Y reconstruction seems superior to B-I reconstruction for preventing both bile reflux into the gastric remnant and postoperative complications. We consider R-Y reconstruction as a feasible and safe method for LADG.

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Authors+Show Affiliations

Kojima K
Departments of Esophagogastric Surgery, Graduate School, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan. k-kojima.srg2@tmd.ac.jp
Yamada H
No affiliation info available
Inokuchi M
No affiliation info available
Kawano T
No affiliation info available
Sugihara K
No affiliation info available

MeSH

Anastomosis, Roux-en-YChi-Square DistributionFemaleGastrectomyHumansLaparoscopyMaleMiddle AgedNutritional StatusPostoperative ComplicationsReconstructive Surgical ProceduresStatistics, NonparametricStomach NeoplasmsTreatment Outcome

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18520223

Citation

Kojima, Kazuyuki, et al. "A Comparison of Roux-en-Y and Billroth-I Reconstruction After Laparoscopy-assisted Distal Gastrectomy." Annals of Surgery, vol. 247, no. 6, 2008, pp. 962-7.
Kojima K, Yamada H, Inokuchi M, et al. A comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg. 2008;247(6):962-7.
Kojima, K., Yamada, H., Inokuchi, M., Kawano, T., & Sugihara, K. (2008). A comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gastrectomy. Annals of Surgery, 247(6), 962-7. https://doi.org/10.1097/SLA.0b013e31816d9526
Kojima K, et al. A Comparison of Roux-en-Y and Billroth-I Reconstruction After Laparoscopy-assisted Distal Gastrectomy. Ann Surg. 2008;247(6):962-7. PubMed PMID: 18520223.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gastrectomy. AU - Kojima,Kazuyuki, AU - Yamada,Hiroyuki, AU - Inokuchi,Mikito, AU - Kawano,Tatsuyuki, AU - Sugihara,Kenichi, PY - 2008/6/4/pubmed PY - 2008/6/27/medline PY - 2008/6/4/entrez SP - 962 EP - 7 JF - Annals of surgery JO - Ann Surg VL - 247 IS - 6 N2 - OBJECTIVE: The present study evaluated the efficacy of Roux-en-Y (R-Y) reconstruction and Billroth-I (B-I) reconstruction after laparoscopy-assisted distal gastrectomy (LADG). PATIENTS AND METHODS: Between October 2000 and February 2006, a total of 133 consecutive patients who underwent LADG for gastric carcinoma were classified into 2 groups according to reconstruction (B-I, n = 65; R-Y, n = 68). Parameters analyzed included patients and tumor characteristics, operative details, postoperative outcomes, and nourishment state. Endoscopic findings of the gastric remnant and lower esophagus were evaluated at 12 months postoperatively. RESULTS: Regarding postoperative complications, no significant differences were found between groups. In the B-I group, 3 patients developed anastomotic leakage and 4 patients suffered anastomotic stricture requiring endoscopic balloon dilation. So-called functional stasis after R-Y reconstruction was not found in this study. Incidence of heartburn at 12 months postoperatively was 37% in the B-I group and 8% in the R-Y group (P = 0.0002). Amount of meal consumed compared with preoperative value at 12 months postoperatively was significantly higher for the R-Y group than for the B-I group (83.6% +/- 15.3% vs. 77.8% +/- 16.0%; P = 0.047). Endoscopic findings showed that incidence of remnant gastritis was significantly lower in the R-Y group than in the B-I group (12% vs. 34%; P = 0.002). Bile reflux into the remnant stomach was not observed in the R-Y group. CONCLUSION: R-Y reconstruction seems superior to B-I reconstruction for preventing both bile reflux into the gastric remnant and postoperative complications. We consider R-Y reconstruction as a feasible and safe method for LADG. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/18520223/A_comparison_of_Roux_en_Y_and_Billroth_I_reconstruction_after_laparoscopy_assisted_distal_gastrectomy_ L2 - https://Insights.ovid.com/pubmed?pmid=18520223 DB - PRIME DP - Unbound Medicine ER -