title: Double tract reconstruction after distal gastrectomy for gastric cancer is effective in reducing reflux esophagitis and remnant gastritis with duodenal passage preservation.
abstract: OBJECTIVE
  So far, there have been no reports assessing double tract (DT) reconstruction after distal gastrectomy for gastric cancer, which maintains the duodenal passage of food. The aim of this study was to evaluate the clinical results of DT reconstruction compared with Roux-en-Y (RY) and Billroth I (BI) reconstruction following distal gastrectomy.
  
  
  METHODS
  Outcomes following DT (33 patients), RY (38 patients), or BI (47 patients) reconstructions were investigated retrospectively. These outcomes included postoperative esophagogastroscopic findings, the angle of His measured from postoperative esophagogastrography, and the quality of life, determined by the Gastrointestinal Symptom Rating Scale (GSRS) 1 year after surgery.
  
  
  RESULTS
  The degree and extent of gastritis was significantly lower in patients who had undergone DT or RY compared with BI reconstruction (P < 0.05). The angle of His was significantly greater in patients who had undergone BI rather than RY or DT reconstruction (P < 0.05) and was significantly greater in patients with reflux esophagitis (P < 0.05). Using the GSRS, patients who underwent DT or RY reconstructions had significantly lower reflux and indigestion than patients who had undergone BI reconstruction. The length of the lesser curvature of the remnant stomach did not differ significantly between the three reconstruction procedures.
  
  
  CONCLUSIONS
  DT reconstruction following distal gastrectomy should be considered as a reconstruction technique as it allows future endoscopic investigation in cases with postoperative problems and results in low levels of reflux esophagitis and remnant gastritis.
authors: Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku, Kochi 783-8505, Japan. tsutomun@kochi-u.ac.jp
authors: Tsutomu
authors: T
authors: Namikawa
authors: Hiroyuki
authors: H
authors: Kitagawa
authors: Takehiro
authors: T
authors: Okabayashi
authors: Takeki
authors: T
authors: Sugimoto
authors: Michiya
authors: M
authors: Kobayashi
authors: Kazuhiro
authors: K
authors: Hanazaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D016009:Chi-Square Distribution; D004386:Duodenum / Q000601:surgery; D004942:Esophagitis, Peptic / Q000209:etiology / Q000517:prevention & control*; D004945:Esophagoscopy; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D018530:Gastric Stump / Q000601:surgery; D005756:Gastritis / Q000209:etiology / Q000517:prevention & control*; D005763:Gastroenterostomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome