title: Durable Flap-Valve Mitigation of Duodenogastric Reflux,  Remnant Gastritis and Dumping Syndrome Following Billroth I Reconstruction.
abstract: BACKGROUND
  We have reported the short-term results of pylorus reconstruction gastrectomy (PRG) that prevents duodenogastric reflux (DGR) and remnant gastritis after distal gastrectomy. We herein report the long-term results of the PRG.
  
  
  METHODS
  PRG was performed in 37 patients (age 31 to 86 [mean 67.8 ± 12.3] years, male:female = 22:15) with gastric cancer from June 2006 through December 2013. We examined the long-term outcome in 28 patients (age 41 to 86 [mean 67.0 ± 10.7] years, male:female = 18:10) that passed over 3 years after surgery (LTR 44.1 ± 11.7 months), and compared with their short-term result after the operation (STR 13.1 ± 6.9 months). The adverse events of gastric surgery evaluated in this study consisted of the degree of remnant gastritis, the presence of dumping syndrome, and degree of weight loss (%).
  
  
  RESULTS
  There was no difference in the degree of DGR and remnant gastritis by gastroscopic finding between LTR and STR after PRG (P = 0.21). Statistically, there was no difference in the bile acid concentration of remnant gastric juice between LTR and STR (108.4 ± 254.1 vs. 94.0 ± 208.6 μmol/L, P = 0.33), and weight loss of LTR was the same as that of STR (5.67 ± 7.08 vs. 4.59 ± 5.63%, P = 0.34). There were few morphological changes in the reconstructed pylorus by the long-term course, but 2 patients showed mild atrophy.
  
  
  CONCLUSIONS
  The form of reconstructed pylorus and the effect that reduces side effects of Billroth I seem to last for a long time.
authors.affiliation: Department of Surgery, Daisan Hospital, The Jikei University School of Medicine, 4-11-1, Izumihon-cho, Komae-si, Tokyo, 201-8601, Japan. hoya@jikei.ac.jp.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Hoya
authors.affiliation: Department of Surgery, Daisan Hospital, The Jikei University School of Medicine, 4-11-1, Izumihon-cho, Komae-si, Tokyo, 201-8601, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Taki
authors.affiliation: Department of Surgery, Daisan Hospital, The Jikei University School of Medicine, 4-11-1, Izumihon-cho, Komae-si, Tokyo, 201-8601, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Watanabe
authors.affiliation: Department of Surgery, Daisan Hospital, The Jikei University School of Medicine, 4-11-1, Izumihon-cho, Komae-si, Tokyo, 201-8601, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Nakayoshi
authors.affiliation: Department of Surgery, Daisan Hospital, The Jikei University School of Medicine, 4-11-1, Izumihon-cho, Komae-si, Tokyo, 201-8601, Japan.
authors.forename: Tomoyoshi
authors.initials: T
authors.lastname: Okamoto
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Mitsumori
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004377:Dumping Syndrome / Q000209:etiology / Q000517:prevention & control*; D004383:Duodenogastric Reflux / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D018530:Gastric Stump / Q000601:surgery; D005756:Gastritis / Q000209:etiology / Q000517:prevention & control*; D005763:Gastroenterostomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011708:Pylorus / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery*; D013997:Time Factors; D015431:Weight Loss
keywords: Billroth I; Dumping syndrome; Duodenogastric reflux; New technique; Pylorus reconstruction; Remnant gastritis