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A comparative study of gastrectomy without vagotomy with either Roux-en-Y or Billroth II anastomosis in peptic ulcer.
Hepatogastroenterology. 1994 Jun; 41(3):294-7.H

Abstract

Since recent small uncontrolled studies have suggested that surgery for peptic ulcer comprising partial gastrectomy with Roux-en-Y anastomosis without vagotomy effectively prevents postoperative enterogastric reflux without increasing ulcer recurrence rate, we have compared mortality, ulcer recurrence rate, and complaints in ulcer patients who had undergone partial gastrectomy with either Roux-en-Y (n = 47) or Billroth II anastomosis (n = 47). The groups were comparable with regard to age, sex, ulcer localisation, indication for surgery and number of emergency procedures. During postoperative follow-up, seven patients with Roux-en-Y have died, compared with nine patients with Billroth II gastrectomy. In two of the seven patients who died after Roux-en-Y gastrectomy, but in none of the nine who died after Billroth II resection, death was unequivocally related to postoperative ulcer recurrences. At 1, 2, 3 and 4 years postoperatively, 90 vs. 100% (not significant), 78 vs. 98% (p < 0.01), 72 vs. 95% (p < 0.01) and 72 vs. 95% (p < 0.01) of the patients were in remission after Roux-en-Y and Billroth II gastrectomy, respectively. All ulcers were localized at or just distal to the anastomosis, and were diagnosed within the first 3 postoperative years. We conclude that in peptic ulcer patients the ulcer recurrence rate after Roux-en-Y gastrectomy without vagotomy is considerably higher than after Billroth II resection. Thus, gastrectomy with Roux-en-Y anastomosis without vagotomy cannot be recommended as the primary procedure in patients undergoing partial gastrectomy for peptic ulcer disease.

Authors+Show Affiliations

Rieu PM
Department of Surgery, Canisius-Wilhelmina Hospital, Leiden, The Netherlands.
Joosten HJ
No affiliation info available
Jansen JB
No affiliation info available
Lamers CB
No affiliation info available

MeSH

AdolescentAdultAgedAged, 80 and overAnastomosis, Roux-en-YElective Surgical ProceduresEmergenciesFemaleFollow-Up StudiesGastrectomyHumansMaleMiddle AgedPeptic UlcerPostoperative ComplicationsProspective StudiesRecurrenceTreatment Outcome

Pub Type(s)

Clinical Trial
Comparative Study
Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

7959558

Citation

Rieu, P M., et al. "A Comparative Study of Gastrectomy Without Vagotomy With Either Roux-en-Y or Billroth II Anastomosis in Peptic Ulcer." Hepato-gastroenterology, vol. 41, no. 3, 1994, pp. 294-7.
Rieu PM, Joosten HJ, Jansen JB, et al. A comparative study of gastrectomy without vagotomy with either Roux-en-Y or Billroth II anastomosis in peptic ulcer. Hepatogastroenterology. 1994;41(3):294-7.
Rieu, P. M., Joosten, H. J., Jansen, J. B., & Lamers, C. B. (1994). A comparative study of gastrectomy without vagotomy with either Roux-en-Y or Billroth II anastomosis in peptic ulcer. Hepato-gastroenterology, 41(3), 294-7.
Rieu PM, et al. A Comparative Study of Gastrectomy Without Vagotomy With Either Roux-en-Y or Billroth II Anastomosis in Peptic Ulcer. Hepatogastroenterology. 1994;41(3):294-7. PubMed PMID: 7959558.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparative study of gastrectomy without vagotomy with either Roux-en-Y or Billroth II anastomosis in peptic ulcer. AU - Rieu,P M, AU - Joosten,H J, AU - Jansen,J B, AU - Lamers,C B, PY - 1994/6/1/pubmed PY - 1994/6/1/medline PY - 1994/6/1/entrez SP - 294 EP - 7 JF - Hepato-gastroenterology JO - Hepatogastroenterology VL - 41 IS - 3 N2 - Since recent small uncontrolled studies have suggested that surgery for peptic ulcer comprising partial gastrectomy with Roux-en-Y anastomosis without vagotomy effectively prevents postoperative enterogastric reflux without increasing ulcer recurrence rate, we have compared mortality, ulcer recurrence rate, and complaints in ulcer patients who had undergone partial gastrectomy with either Roux-en-Y (n = 47) or Billroth II anastomosis (n = 47). The groups were comparable with regard to age, sex, ulcer localisation, indication for surgery and number of emergency procedures. During postoperative follow-up, seven patients with Roux-en-Y have died, compared with nine patients with Billroth II gastrectomy. In two of the seven patients who died after Roux-en-Y gastrectomy, but in none of the nine who died after Billroth II resection, death was unequivocally related to postoperative ulcer recurrences. At 1, 2, 3 and 4 years postoperatively, 90 vs. 100% (not significant), 78 vs. 98% (p < 0.01), 72 vs. 95% (p < 0.01) and 72 vs. 95% (p < 0.01) of the patients were in remission after Roux-en-Y and Billroth II gastrectomy, respectively. All ulcers were localized at or just distal to the anastomosis, and were diagnosed within the first 3 postoperative years. We conclude that in peptic ulcer patients the ulcer recurrence rate after Roux-en-Y gastrectomy without vagotomy is considerably higher than after Billroth II resection. Thus, gastrectomy with Roux-en-Y anastomosis without vagotomy cannot be recommended as the primary procedure in patients undergoing partial gastrectomy for peptic ulcer disease. SN - 0172-6390 UR - https://www.unboundmedicine.com/medline/citation/7959558/A_comparative_study_of_gastrectomy_without_vagotomy_with_either_Roux_en_Y_or_Billroth_II_anastomosis_in_peptic_ulcer_ L2 - https://medlineplus.gov/pepticulcer.html DB - PRIME DP - Unbound Medicine ER -