Comparison of Billroth I and Billroth II reconstructions after laparoscopy-assisted distal gastrectomy: a retrospective analysis of large-scale multicenter results from Korea.
BACKGROUND
Since reconstruction after laparoscopy-assisted distal gastrectomy (LADG) is performed through a small minilaparotomy window, the clinical course and complication rate are influenced by clinical technical expertise and experience. The aim of this study was to compare postoperative complications and survival rates of Billroth I and Billroth II reconstructions after LADG.


METHODS
We retrospectively collected data from 1,259 patients who underwent LADG performed by ten surgeons at ten hospitals between April 1998 and December 2005. Patients were classified into two groups according to reconstruction method used: the Billroth I group (n=875) and the Billroth II group (n=384). Patient and tumor characteristics, operative details, and postoperative complications were analyzed.


RESULTS
Billroth II reconstruction was performed on obese patients (p=0.003) and patients with more advanced tumors (p<0.001). Billroth I reconstruction was performed more frequently in the lower portion of the stomach (p<0.001) and yielded shorter operating times. The postoperative complication rate was 11.4% in the Billroth I group, which was lower than that in the Billroth II group (16.9%) (p=0.011). However, the differences in the major complication rates were not statistically significant (p=0.263). Of the intra-abdominal complications, intraluminal or intraperitoneal bleeding was the most frequent complication in the Billroth I group and duodenal stump leakage was the most frequent in the Billroth II group. The postoperative mortality rate did not show a statistically significant difference.


CONCLUSIONS
Both Billroth I and Billroth II techniques are feasible and safe reconstruction methods after LADG for gastric cancer. To reduce major complication rates, surgeons should pay attention to bleeding in Billroth I reconstruction and stump leakage in Billroth II reconstruction.
Department of Surgery, Soonchunhyang University Bucheon Hospital, 1174, Jung-dong, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-767, Korea.
Kyu-Chul
KC
Kang
Gyu Seok
GS
Cho
Sang Uk
SU
Han
Wook
W
Kim
Hyung-Ho
HH
Kim
Min-Chan
MC
Kim
Woo Jin
WJ
Hyung
Seong Yeob
SY
Ryu
Seung Wan
SW
Ryu
Hyuk Joon
HJ
Lee
Kyo Young
KY
Song
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005763:Gastroenterostomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D010535:Laparoscopy; D016015:Logistic Models; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D056910:Republic of Korea; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D017792:Surgical Stapling; D016896:Treatment Outcome