Jejunal interposition helps prevent reflux gastritis.
OBJECTIVE
Jejunal interposition after distal gastrectomy is reported to prevent both duodenogastric reflux and rapid gastric emptying. However, comparing primary reconstruction with this procedure and Billroth-I in terms of clinical evaluation by the same surgeon is rare. In this study, the benefit of this procedure was retrospectively evaluated as compared to the Billroth-I method.


METHODS
Of 30 patients with early gastric cancer located at the middle third of the stomach, 15 underwent distal gastrectomy with jejunal interposition and the other 15 underwent Billroth-I gastrectomy by the same surgeon. Isoperistaltic jejunal interposition measuring 10-12 cm was used. All the anastomoses without jejunojejunostomy were performed using auto-suture staplers. Assessment of postoperative symptoms and functions was performed one year after surgery.


RESULTS
The mean operation time was significantly longer after jejunal interposition (p < 0.01). No serious complications occurred in either group, and the hospital stay after operation was also similar. There were no significant differences in terms of postoperative symptoms, food intake, and recovery of body weight. The incidence of bile regurgitation and reflux gastritis was very low or zero in the jejunal interposition group, which indicated differences (p < 0.05, p < 0.01, respectively). Reflux esophagitis was not found in jejunal interposition, but two patients after Billroth I showed grade B esophagitis. As regards gastric emptying, the retention capacity was very poor and there was no significant difference between the two groups.


CONCLUSIONS
Jejunal interposition after distal gastrectomy was superior to the Billroth-I procedure in terms of reflux gastritis prevention. However, dumping syndrome and rapid gastric emptying were not prevented.
Nakane
Yasushi
Y
Second Department of Surgery, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka, 570, Japan. nakaney@takii.kmu.ac.jp
Michiura
Taku
T
Inoue
Kentaro
K
Habara
Kohzo
K
Nakai
Koji
K
Sato
Mutuya
M
Okumura
Shunichiro
S
Yamamichi
Keigo
K
D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005746:Gastric Emptying; D005756:Gastritis / Q000517:prevention & control*; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017792:Surgical Stapling