title: Reconstructive procedure after distal gastrectomy for gastric cancer that best prevents duodenogastroesophageal reflux.
abstract: Billroth I and II reconstructions are commonly performed after distal gastrectomy. Both may cause duodenogastric and duodenogastroesophageal reflux, conditions reported to have carcinogenetic potential. The aim of this study was to investigate which reconstructive procedure would most effectively prevent bile reflux into the gastric remnant and esophagus after distal gastrectomy. A group of 92 patients who underwent curative distal gastrectomy for gastric cancer were subjected and classified into three groups retrospectively by the reconstructive procedure undertaken: group A, Roux-en-Y (Roux-Y) reconstruction (n = 29); group B, Billroth I reconstruction (n = 41); group C, Billroth II reconstruction (n = 22). The bile reflux periods (percent time) for the gastric remnant and esophagus were measured with the Bilitec 2000 under standardized conditions. The percent time for the gastric remnant was significantly less in group A than in group B or C. In 61% of all patients, bile reflux into the esophagus was found to be more than 5.0% of the time; it was less in group A than in group B or C (p = 0.057). A questionnaire revealed a good correlation between the incidence of reflux symptoms and the percent time for the gastric remnant and esophagus. Roux-Y reconstruction is superior to either Billroth I or II reconstruction for preventing bile reflux into the gastric remnant and esophagus after distal gastrectomy.
authors.affiliation: Second Department of Surgery, Osaka City University Medical School, 1-4-3 Asahimachi Abeno-ku, Osaka 545-8586, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Fukuhara
authors.forename: Harushi
authors.initials: H
authors.lastname: Osugi
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Takada
authors.forename: Masashi
authors.initials: M
authors.lastname: Takemura
authors.forename: Masayuki
authors.initials: M
authors.lastname: Higashino
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D004383:Duodenogastric Reflux / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D005763:Gastroenterostomy / Q000379:methods*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011178:Postgastrectomy Syndromes / Q000209:etiology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome