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Latest results (12-21 years) of a prospective randomized study comparing Billroth II and Roux-en-Y anastomosis after a partial gastrectomy plus vagotomy in patients with duodenal ulcers.
Ann Surg. 2009 Feb; 249(2):189-94.AnnS

Abstract

INTRODUCTION

After a partial resection of the stomach, the continuity of the gastrointestinal tract can be restored either by a Billroth II gastrojejunal anastomosis or a Roux-en-Y gastrojejunostomy. Each procedure has its advantages and disadvantages.

OBJECTIVE

To determine through a prospective and random clinical trial, the clinical outcome and the endoscopic and histologic alterations of the distal esophagus and the gastric remnant in patients who received a partial distal gastrectomy due to duodenal ulcers and a Billroth II or Roux-en-Y reconstruction.

MATERIAL AND METHODS

In this prospective random trial, a total of 75 patients with duodenal ulcers were included. A bilateral selective vagotomy and partial distal gastrectomy were performed in all patients. A Billroth II or Roux-en-Y 60-cm-long loop was randomly used for reconstruction of the gastrointestinal tract. During the latest follow-up clinical evaluation, upper endoscopy and biopsy samples from the distal esophagus and gastric remnant were obtained.

RESULTS

There was 1 operative mortality and 6 patients had some morbidity. The average follow-up period was 15.5 years (range, 11-21). Patients with Roux-en-Y gastrojejunostomy were significantly more asymptomatic and had greater Visick I grading than patients with Billroth II reconstruction (P < 0.001). In the distal esophagus, endoscopic findings were normal in 90% of the Roux-en-Y group, but only in 51% of the Billroth II group (P < 0.0009). Nearly 25% of the latter group had the appearance of a short-segment Barrett esophagus compared with 3% of the Roux-en-Y group (P < 0.0001). The gastric remnant endoscopic findings were normal in 100% of the Roux-en-Y group and in 18% of the Billroth II group (P < 0.02). Histologic analyses showed similar proportions of normal fundic mucosa and chronic active fundic gastritis. However, chronic atrophic fundic gastritis and intestinal metaplasia were significantly more frequent after Billroth II reconstruction (P < 0.008). Helicobacter pylorus was present in a similar proportion of patients.

CONCLUSIONS

This prospective and random study showed that Roux-en-Y gastrojejunostomy is significantly better than a Billroth II reconstruction in patients with duodenal ulcers, through subjective and objective endoscopic and histologic evaluations during the latest follow-up evaluation.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Csendes A
Departments of Surgery, University of Chile, Santiago. acsendes@redclinicauchile.cl
Burgos AM
No affiliation info available
Smok G
No affiliation info available
Burdiles P
No affiliation info available
Braghetto I
No affiliation info available
Díaz JC
No affiliation info available

MeSH

AdolescentAdultAgedAnastomosis, Roux-en-YDuodenal UlcerEsophagusFemaleFollow-Up StudiesGastrectomyGastroenterostomyHumansMaleMiddle AgedProspective StudiesStomachTreatment OutcomeVagotomyYoung Adult

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19212169

Clinical Trial Links

Washed Microbiota Transplantation for Malnutrition After Upper Gastrointestinal Rerouting Surgery

Citation

Csendes, Atilla, et al. "Latest Results (12-21 Years) of a Prospective Randomized Study Comparing Billroth II and Roux-en-Y Anastomosis After a Partial Gastrectomy Plus Vagotomy in Patients With Duodenal Ulcers." Annals of Surgery, vol. 249, no. 2, 2009, pp. 189-94.
Csendes A, Burgos AM, Smok G, et al. Latest results (12-21 years) of a prospective randomized study comparing Billroth II and Roux-en-Y anastomosis after a partial gastrectomy plus vagotomy in patients with duodenal ulcers. Ann Surg. 2009;249(2):189-94.
Csendes, A., Burgos, A. M., Smok, G., Burdiles, P., Braghetto, I., & Díaz, J. C. (2009). Latest results (12-21 years) of a prospective randomized study comparing Billroth II and Roux-en-Y anastomosis after a partial gastrectomy plus vagotomy in patients with duodenal ulcers. Annals of Surgery, 249(2), 189-94. https://doi.org/10.1097/SLA.0b013e3181921aa1
Csendes A, et al. Latest Results (12-21 Years) of a Prospective Randomized Study Comparing Billroth II and Roux-en-Y Anastomosis After a Partial Gastrectomy Plus Vagotomy in Patients With Duodenal Ulcers. Ann Surg. 2009;249(2):189-94. PubMed PMID: 19212169.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Latest results (12-21 years) of a prospective randomized study comparing Billroth II and Roux-en-Y anastomosis after a partial gastrectomy plus vagotomy in patients with duodenal ulcers. AU - Csendes,Atilla, AU - Burgos,Ana Maria, AU - Smok,Gladys, AU - Burdiles,Patricio, AU - Braghetto,Italo, AU - Díaz,Juan Carlos, PY - 2009/2/13/entrez PY - 2009/2/13/pubmed PY - 2009/3/6/medline SP - 189 EP - 94 JF - Annals of surgery JO - Ann Surg VL - 249 IS - 2 N2 - INTRODUCTION: After a partial resection of the stomach, the continuity of the gastrointestinal tract can be restored either by a Billroth II gastrojejunal anastomosis or a Roux-en-Y gastrojejunostomy. Each procedure has its advantages and disadvantages. OBJECTIVE: To determine through a prospective and random clinical trial, the clinical outcome and the endoscopic and histologic alterations of the distal esophagus and the gastric remnant in patients who received a partial distal gastrectomy due to duodenal ulcers and a Billroth II or Roux-en-Y reconstruction. MATERIAL AND METHODS: In this prospective random trial, a total of 75 patients with duodenal ulcers were included. A bilateral selective vagotomy and partial distal gastrectomy were performed in all patients. A Billroth II or Roux-en-Y 60-cm-long loop was randomly used for reconstruction of the gastrointestinal tract. During the latest follow-up clinical evaluation, upper endoscopy and biopsy samples from the distal esophagus and gastric remnant were obtained. RESULTS: There was 1 operative mortality and 6 patients had some morbidity. The average follow-up period was 15.5 years (range, 11-21). Patients with Roux-en-Y gastrojejunostomy were significantly more asymptomatic and had greater Visick I grading than patients with Billroth II reconstruction (P < 0.001). In the distal esophagus, endoscopic findings were normal in 90% of the Roux-en-Y group, but only in 51% of the Billroth II group (P < 0.0009). Nearly 25% of the latter group had the appearance of a short-segment Barrett esophagus compared with 3% of the Roux-en-Y group (P < 0.0001). The gastric remnant endoscopic findings were normal in 100% of the Roux-en-Y group and in 18% of the Billroth II group (P < 0.02). Histologic analyses showed similar proportions of normal fundic mucosa and chronic active fundic gastritis. However, chronic atrophic fundic gastritis and intestinal metaplasia were significantly more frequent after Billroth II reconstruction (P < 0.008). Helicobacter pylorus was present in a similar proportion of patients. CONCLUSIONS: This prospective and random study showed that Roux-en-Y gastrojejunostomy is significantly better than a Billroth II reconstruction in patients with duodenal ulcers, through subjective and objective endoscopic and histologic evaluations during the latest follow-up evaluation. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/19212169/Latest_results__12_21_years__of_a_prospective_randomized_study_comparing_Billroth_II_and_Roux_en_Y_anastomosis_after_a_partial_gastrectomy_plus_vagotomy_in_patients_with_duodenal_ulcers_ DB - PRIME DP - Unbound Medicine ER -