Effectiveness of Roux-en-Y reconstruction after distal gastrectomy based on an assessment of biliary kinetics.
OBJECTIVE
To evaluate the efficiency of Roux-en-Y reconstruction (RY) after distal gastrectomy we compared postoperative physiological functions and disorders among patients who underwent RY, conventional Billroth I reconstruction (BI), or Billroth II reconstruction (BII).


METHODS
The subjects were 91 patients who had undergone distal gastrectomy for gastric cancer more than 1 month earlier. To examine the severity of gastroesophageal reflux, acid reflux and alkali reflux were assessed, and to examine the severity of duodenal reflux into the remnant stomach, biliary scintigraphy was performed. The degree of inflammation in the esophagus and remnant stomach was examined by endoscopy. Questionnaires on postoperative complaints were sent out to the patients to determine how serious their reflux symptoms were.


RESULTS
Both acid and alkali reflux were mild in the RY group. Biliary reflux into the remnant stomach, as assessed by biliary scintigraphy, was significantly less severe in the RY group than in the BI and BII groups. Endoscopy showed that inflammation of the lower esophagus and remnant stomach was much less severe in the RY group than in the BI and BII groups. According to the questionnaire survey, none of the patients in the RY group reported any reflux symptoms.


CONCLUSIONS
In this series, RY was found to be a superior reconstruction method after distal gastrectomy since it was rarely accompanied by the reflux of duodenal juice into the remnant stomach or gastric reflux into the lower esophagus.
Shinoto
Koichi
K
Second Department of Surgery, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Japan.
Ochiai
Takenori
T
Suzuki
Takao
T
Okazumi
Shin-Ichi
S
Ozaki
Masahiko
M
D000713:Anastomosis, Roux-en-Y; D004383:Duodenogastric Reflux / Q000000981:diagnostic imaging / Q000517:prevention & control*; D005743:Gastrectomy; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000517:prevention & control*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control*; D011877:Radionuclide Imaging; D019651:Plastic Surgery Procedures; D013274:Stomach Neoplasms / Q000503:physiopathology / Q000601:surgery; D011795:Surveys and Questionnaires