Histological changes in the gastric stump mucosa and late clinical results after Billroth I, Billroth II and Roux-en-Y operations for peptic ulcer disease.
To study the morphological alterations and clinical outcome after gastric resection 53 patients operated on for peptic ulcer disease 5 to 7 years earlier were analyzed. The type of reconstruction was either Billroth I (n = 16), Billroth II (n = 19) or Roux-en-Y (n = 18). Vagotomy was combined with Billroth II in 7 (31%) cases and with Roux-en-Y in 8 (44%) cases. According to a modified Visick classification the late functional results were similar after Billroth reconstructions, whereas failures were most often after Roux-en-Y reconstruction (28%). No ulcer recurrences were found. The histological findings were similar in the operative specimens, but biopsies from the gastric stump mucosa 5 to 7 years after surgery showed significantly (P less than 0.05) more atrophic gastritis after Billroth operations than after Roux-en-Y reconstruction. No dysplastic changes were found. It is concluded that Roux-en-Y reconstruction causes least changes in the gastric stump mucosa after gastric resection. The delayed gastric emptying associated with this procedure may, however, cause late functional disturbances.
Ovaska
J T
JT
Second Department of Surgery, University Central Hospital, Helsinki, Finland.
Ekfors
T O
TO
Luukkonen
P E
PE
Lempinen
M J
MJ
D000713:Anastomosis, Roux-en-Y; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology*; D005756:Gastritis / Q000473:pathology*; D005757:Gastritis, Atrophic / Q000473:pathology*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D010437:Peptic Ulcer / Q000601:surgery*; D011183:Postoperative Complications / Q000473:pathology*; D011230:Precancerous Conditions / Q000473:pathology*; D013274:Stomach Neoplasms / Q000473:pathology*