[Restoration of digestive continuity after subtotal gastrectomy: comparison of the methods of Billroth I, Billroth II and roux en Y. Randomized prospective study].
The aim of this study was to evaluate functional results after Billroth I, Billroth II and Roux en Y reconstruction in subtotal gastrectomy.


METHODS
45 patients were randomised between 1990 and 1995 and stratified in 3 different groups: 15 BI, 15 BII and 15 Roux. They were investigated by EGDS with multiple biopsies and upper gastro-intestinal scintiscanning, to evaluate gastro-esophageal reflux (GER) and dynamics of gastric emptying. Besides they answered a questionnaire: "Gastrointestinal Quality of Life Index" (GIQLI).


RESULTS
A reflux esophagitis was found in 5 BI, in 7 BII and in 2 Roux (p < 0.001). No gastric lesions were found in 6 BI, in 5 BII and in 12 Roux, (BI vs. Y, p < 0.05; BII vs. Y, p < 0.001). Chronic superficial gastritis was present in 9 BI, in 4 BII and in 3 Roux (BI vs. Y, p < 0.05). Dynamic scintiscan demonstrated the presence of GER in 5 BI and gastric emptying was fast (37' < T 1/2 < 86'), but incomplete (60' residual activity: 49-62%). GER was evident in 7 BII with slow (28' < T 1/2 < 143') and incomplete (60' residual activity: 48-72%) gastric emptying. GER was detected in 2 Roux and radioactive bolus progression in the Roux limb was fast (24' < T 1/2 < 53') and complete (60 residual activity: 42-52%) (BI vs. Y; BII vs. Y, p < 0,001). There was not statistical significance between GIQLI score in the 3 groups.


CONCLUSIONS
The authors affirm the Roux en Y is the technique of choice in subtotal gastrectomy, if compared with BI and BII.
D'Amato
A
A
Policlinico Umberto I, Università degli Studi di Roma La Sapienza.
Montesani
C
C
Cristaldi
M
M
Giovannini
C
C
Pronio
A
A
Santella
S
S
Ventroni
G
G
Ronga
G
G
Ribotta
G
G
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005756:Gastritis / Q000209:etiology; D005764:Gastroesophageal Reflux / Q000209:etiology; D005767:Gastrointestinal Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011877:Radionuclide Imaging; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
Ripristino della continuità digestiva dopo gastrectomia subtotale: confronto tra la Billroth I, la Billroth II e l'ansa ad Y. Studio prospettico randomizzato.