title: Prospective randomized trial comparing Billroth I and Roux-en-Y procedures after distal gastrectomy for gastric carcinoma.
abstract: To determine the clinical efficacy of Roux-en-Y reconstruction (RY) after distal gastrectomy, we compared postoperative outcomes of patients who underwent RY or conventional Billroth I reconstruction (B-I). A total of 50 patients were prospectively randomized to either B-I or RY reconstruction, and complications, postoperative course, and nutritional status were compared. Bile reflux and inflammation in the remnant stomach and lower esophagus were evaluated by postoperative follow-up endoscopy at 6 months. Operative time and blood loss as well as postoperative nutrition did not show significant differences between the two groups. As anticipated, 5 of 24 patients with RY reconstruction developed gastrojejunal stasis in the early postoperative period, which led to a longer postoperative hospital stay as compared with the B-I group (mean +/- S.D; B-I; 19.0 +/- 6.2, RY; 31.8 +/- 21.7 days) (P < 0.05). Endoscopic examination revealed that the frequency of bile reflux (P < 0.01) and degree of inflammation in the remnant stomach (P < 0.05) were less in the RY group than in the B-I group. However, inflammatory findings in the lower esophagus were observed in 7 (27%) of B-I, and 8 (35%) of the RY group, suggesting that late phase esophagitis was not improved in the RY group. Roux-en-Y reconstruction was effective in preventing duodenogastric reflux and resulting gastritis, but it did not prevent esophagitis. Because RY reconstruction induces the frequent complication of Roux-en-Y stasis, causing longer postoperative hospital stay, this method has limited advantages over B-I anastomosis after distal gastrectomy.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bankyo-ku, Tokyo 113-8655, Japan. makoto-ishi@umin.ac.jp
authors.forename: Makoto
authors.initials: M
authors.lastname: Ishikawa
authors.forename: Joji
authors.initials: J
authors.lastname: Kitayama
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kaizaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakayama
authors.forename: Hironori
authors.initials: H
authors.lastname: Ishigami
authors.forename: Shin
authors.initials: S
authors.lastname: Fujii
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Suzuki
authors.forename: Tomomi
authors.initials: T
authors.lastname: Inoue
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sako
authors.forename: Masahiro
authors.initials: M
authors.lastname: Asakage
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Yamashita
authors.forename: Kenji
authors.initials: K
authors.lastname: Hatono
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Nagawa
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D016063:Blood Loss, Surgical; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D009752:Nutritional Status; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome