Reconstructive procedure after distal gastrectomy to prevent remnant gastritis.
OBJECTIVE
Gastroduodenostomy (Billroth I) or gastrojejunostomy (Billroth II) after distal gastrectomy is associated with duodenogastric reflux and remnant gastritis. This study sought to determine which reconstructive procedure is least likely to cause remnant gastritis and to determine the correlation between duodenogastric reflux and remnant gastritis.


METHODS
Sixty patients who underwent curative distal gastrectomy for gastric cancer were classified into three groups by reconstructive procedure: group A, Roux-Y (n=18); group B, Billroth I (n=25); group C, Billroth II (n=17). Intragastric bile reflux was monitored using the Bilitec 2000 14 days after surgery, and endoscopy was performed and a patient questionnaire was completed 12 weeks after surgery.


RESULTS
Bile reflux occurred in 23.9%, 40.4%, and 73.4% of the time (p<0.001), and remnant gastritis developed in 33%, 76%, and 100% of patients (p<0.001), in groups A, B, and C, respectively. Helicobacter pylori infection did not correlate with remnant gastritis (p=0.57). Symptoms following Roux-Y reconstruction were comparable to those following Billroth I and II reconstructions.


CONCLUSIONS
Roux-Y reconstruction following distal gastrectomy is superior to Billroth I and II reconstruction in preventing remnant gastritis because it reduces duodenogastric reflux.
Osugi
H
H
Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Fukuhara
K
K
Takada
N
N
Takemura
M
M
Kinoshita
H
H
D000368:Aged; D000713:Anastomosis, Roux-en-Y; D004383:Duodenogastric Reflux / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005743:Gastrectomy; D018530:Gastric Stump; D005756:Gastritis / Q000453:epidemiology / Q000517:prevention & control*; D005763:Gastroenterostomy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012086:Reoperation; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D011795:Surveys and Questionnaires