Billroth I versus Billroth II partial gastrectomy in the treatment of gastric ulcer.
Short- and long-term results of B-I and B-II reconstructions were compared in order to assess which anastomosis is to be recommended after partial gastrectomy for gastric ulcer. All the patients (287) electively operated for gastric ulcer 10-20 years ago were considered for the study. Operative mortality did not significantly differ, while duration of post-operative time before discharge and post-operative morbidity were significantly lower after B-I. Long-term percentage probability of survival was higher after B-I than after B-II (87.0 and 63.7 after 19 years, respectively), while quality of life was similar in the two groups. In the 64 subjects (26 B-I and 38 B-II) who underwent the study protocol, fasting bile reflux appeared more abundant and bile acid concentration greater after B-II than after B-I. While bacteria and nitrite concentrations did not differ in the two groups, bile acid pattern differed in a greater deoxycholic acid percentage concentration in the B-II group. In spite of an increased deoxycholic acid concentration and therefore a probably more lithogenic bile, gallstones were shown in 23.11% and 39.41% of the B-I and the B-II subjects, respectively, without significant differences. In conclusion, when partial gastrectomy is indicated for gastric ulcer, B-I reconstruction seems preferable to B-II because of its lower post-operative mobility, less evident entero-gastric reflux and histological consequences, less evident bile acid pattern changes from normal, and an apparently longer life-expectancy after discharge.
Bechi
P
P
Istituto di Clinica Chirurgica Generale & Discipline Chirurgiche, Università di Firenze.
Naspetti
R
R
Mazzanti
R
R
Castiglione
G
G
Tonelli
P
P
Amorosi
A
A
Tonelli
L
L
D000328:Adult; D000368:Aged; D001647:Bile Acids and Salts / Q000378:metabolism; D002423:Cause of Death; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011178:Postgastrectomy Syndromes / Q000453:epidemiology; D011183:Postoperative Complications; D012008:Recurrence; D013276:Stomach Ulcer / Q000378:metabolism / Q000401:mortality / Q000601:surgery*
D001647:Bile Acids and Salts