Roux-en-Y reconstruction after distal gastrectomy to reduce enterogastric reflux and Helicobacter pylori infection.
Enterogastric reflux (EGR) is regarded as an unavoidable consequence of distal gastrectomy. We evaluated the efficacy of Roux-en-Y (RY) gastrojejunostomy and Braun enteroenterostomy (BEE) for preventing EGR. Between January 2002 and January 2005, 60 patients who underwent distal gastrectomy for gastric cancer or peptic ulcers were divided into RY, Billroth II reconstruction (BII) without or with BEE (BII+B) according to reconstructive method. After 12 months, EGR and mucosal alterations of the remnant stomach were evaluated using biliary scintigraphy, endoscopy, and histology. Scintigraphy showed fasting and postprandial EGR into the remnant stomach occurred in 5.3% and 21.1% of the RY group, 62.1% and 93.1% of the BII group, and 50.0% and 91.7% of the BII+B group, respectively. Endoscopy showed bile reflux occurred in 15.8% of the RY group, 75.9% of the BII group, and 83.3% of the BII+B group. In addition, the prevalence of Helicobacter pylori (HP) infection in the RY group was less than in the other groups (P<0.02). Therefore, RY after distal gastrectomy was effective in reducing EGR and HP infection. BEE was ineffective in diverting bile flow away from the gastric remnant.
Chan
De-Chuan
DC
Division of General Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Fan
Yu-Ming
YM
Lin
Chih-Kung
CK
Chen
Cheng-Jueng
CJ
Chen
Ching-Yuan
CY
Chao
You-Chen
YC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D001659:Biliary Tract; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology; D018530:Gastric Stump / Q000473:pathology; D005756:Gastritis / Q000473:pathology / Q000517:prevention & control; D005767:Gastrointestinal Diseases / Q000517:prevention & control*; D016481:Helicobacter Infections / Q000517:prevention & control*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011184:Postoperative Period