Prospective Randomized Trial Comparing Billroth I and Roux‐en‐Y Procedures after Distal Gastrectomy for Gastric Carcinoma

• DOI: 10.1007/s00268-005-7830-0
• Publication Date: 2005-10-20T14:00:30Z
• Authors: Makoto Ishikawa; Joji Kitayama; Shoichi Kaizaki; Hiroshi Nakayama; Hironori Ishigami; Shin Fujii; Hiroyuki Suzuki; Tomomi Inoue; Akihiro Sako; Masahiro Asakage; Hiroharu Yamashita; Kenji Hatono; Hirokazu Nagawa
• Keywords: Anastomosis, Surgical; Blood Loss, Surgical; Nutritional Status; Length of Stay; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Gastrectomy; Stomach Neoplasms; Humans; Prospective Studies

AbstractTo determine the clinical efficacy of Roux‐en‐Y reconstruction (RY) after distal gastrectomy, we compared postoperative outcomes of patients who underwent RY or conventional Billroth I reconstruction (B‐I). A total of 50 patients were prospectively randomized to either B‐I or RY reconstruction, and complications, postoperative course, and nutritional status were compared. Bile reflux and inflammation in the remnant stomach and lower esophagus were evaluated by postoperative follow‐up endoscopy at 6 months. Operative time and blood loss as well as postoperative nutrition did not show significant differences between the two groups. As anticipated, 5 of 24 patients with RY reconstruction developed gastrojejunal stasis in the early postoperative period, which led to a longer postoperative hospital stay as compared with the B‐I group (mean ± S.D; B‐I; 19.0 ± 6.2, RY; 31.8 ± 21.7 days) (P < 0.05). Endoscopic examination revealed that the frequency of bile reflux (P < 0.01) and degree of inflammation in the remnant stomach (P < 0.05) were less in the RY group than in the B‐I group. However, inflammatory findings in the lower esophagus were observed in 7 (27%) of B‐I, and 8 (35%) of the RY group, suggesting that late phase esophagitis was not improved in the RY group. Roux‐en‐Y reconstruction was effective in preventing duodenogastric reflux and resulting gastritis, but it did not prevent esophagitis. Because RY reconstruction induces the frequent complication of Roux‐en‐Y stasis, causing longer postoperative hospital stay, this method has limited advantages over B‐I anastomosis after distal gastrectomy.