title: Long-term comparison of boomerang-shaped jejunal interposition and Billroth-I reconstruction after distal gastrectomy.
abstract: BACKGROUND
  Billroth-I (BI) is a simple, physiological method of reconstruction following distal gastrectomy. In actuality, postoperative QOL is by no means favorable due to the high incidence of post-gastrectomy syndrome. The aim of this study is to assess the safety and efficacy of boomerang-shaped jejunal interposition (BJI) after distal gastrectomy.
  
  
  METHODS
  Sixty-six patients with early gastric cancer underwent the BI procedure (n = 33) or BJI (n = 33) after distal gastrectomy, following which they were compared for 5 years. Tumor characteristics, operative details, postoperative complications and complaints, number of meals, and body weight were analyzed. Patients were followed up by endoscopy every 12 months.
  
  
  RESULTS
  There were no significant differences in the incidence of postoperative complications. The incidence of heartburn (30 vs. 0 %, P = 0.0009) and oral bitterness (33 vs. 6 %, P = 0.0112) were significantly lower in the BJI cases. Endoscopic findings revealed significantly lower incidences of reflux esophagitis (24 vs. 0 %, P = 0.0051) and remnant gastritis (70 vs. 3 %, P < 0.0001) in the BJI group. The incidence of food stasis was low in both groups (12 vs. 15 %). In the BJI group, 30 patients (90 %) were eating 3 meals/day within 12 months, whereas in the BI group, 16 patients (48 %) were still eating 5 meals/day at 12 months or later.
  
  
  CONCLUSIONS
  BJI is as safe as BI, but is better in terms of improvement in bile reflux and food intake without stasis. This procedure, therefore, appears to be a useful method for reconstruction after distal gastrectomy.
authors.affiliation: Department of Surgery 1, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan, k-sasaki@dokkyomed.ac.jp.
authors.forename: Kinro
authors.initials: K
authors.lastname: Sasaki
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Miyachi
authors.forename: Norihito
authors.initials: N
authors.lastname: Yoda
authors.forename: Shinichi
authors.initials: S
authors.lastname: Onodera
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Satomura
authors.forename: Kichiro
authors.initials: K
authors.lastname: Otsuka
authors.forename: Masanobu
authors.initials: M
authors.lastname: Nakajima
authors.forename: Satoru
authors.initials: S
authors.lastname: Yamaguchi
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Sunagawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kato
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001655:Bile Reflux / Q000209:etiology; D004435:Eating; D016099:Endoscopy, Gastrointestinal; D004942:Esophagitis, Peptic / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D005756:Gastritis / Q000209:etiology; D005763:Gastroenterostomy / Q000009:adverse effects; D006356:Heartburn / Q000209:etiology; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011178:Postgastrectomy Syndromes / Q000209:etiology; D011183:Postoperative Complications / Q000601:surgery; D013270:Stomach / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery*; D013997:Time Factors