Skip to main content

Advertisement

SpringerLink
Log in

Comparison of Billroth I and Billroth II reconstructions after laparoscopy-assisted distal gastrectomy: a retrospective analysis of large-scale multicenter results from Korea

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

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.

Patients and 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4(2):146–148

    PubMed  CAS  Google Scholar 

  2. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Study Group (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245(1):68–72

    Article  PubMed  Google Scholar 

  3. Song KY (2007) The current status and future perspectives of laparoscopic surgery for gastric cancer. Korean J Gastroenterol 50(4):233–241

    PubMed  Google Scholar 

  4. Lee SI, Choi YS, Park DJ, Kim HH, Yang HK, Kim MC (2006) Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg 202(6):874–880

    Article  PubMed  Google Scholar 

  5. Kim MC, Kim KH, Kim HH, Jung GJ (2005) Comparison of laparoscopy-assisted by conventional open distal gastrectomy and extraperigastric lymph node dissection in early gastric cancer. J Surg Oncol 91(1):90–94

    Article  PubMed  Google Scholar 

  6. Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241(2):232–237

    Article  PubMed  Google Scholar 

  7. Noshiro H, Nagai E, Shimizu S, Uchiyama A, Tanaka M (2005) Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer. Surg Endosc 19(12):1592–1596

    Article  PubMed  CAS  Google Scholar 

  8. Song KY, Kim SN, Park CH (2008) Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer: technical and oncologic aspects. Surg Endosc 22(3):655–659

    Article  PubMed  CAS  Google Scholar 

  9. Hur H, Jeon HM, Kim W (2008) Laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy for T2b advanced gastric cancers: three years’ experience. J Surg Oncol 98(7):515–519

    Article  PubMed  Google Scholar 

  10. Osugi H, Fukuhara K, Takada N, Takemura M, Kinoshita H (2004) Reconstructive procedure after distal gastrectomy to prevent remnant gastritis. Hepatogastroenterology 51:1215–1218

    PubMed  CAS  Google Scholar 

  11. Nunobe S, Okaro A, Sasako M, Saka M, Fukagawa T, Katai H, Sano T (2007) Billroth 1 versus Roux-en-Y reconstructions: a quality-of-life survey at 5 years. Int J Clin Oncol 12(6):433–439

    Article  PubMed  Google Scholar 

  12. Montesani C, D’Amato A, Santella S, Pronio A, Giovannini C, Cristaldi M, Ribotta G (2002) Billroth I versus Billroth II versus Roux-en-Y after subtotal gastrectomy. Prospective randomized study. Hepatogastroenterology 49(47):1469–1473

    PubMed  Google Scholar 

  13. Persiani R, Antonacci V, Biondi A, Rausei S, La Greca A, Zoccali M, Ciccoritti L, D’Ugo D (2008) Determinants of surgical morbidity in gastric cancer treatment. J Am Coll Surg 207(1):13–19

    Article  PubMed  Google Scholar 

  14. Csendes A, Burgos AM, Smok G, Burdiles P, Braghetto I, Díaz JC (2009) Latest results (12–21 years) of a prospective randomized study comparing Billroth II and Roux-en-Y anastomosis after a partial gastrectomy plus vagotomy in patients with duodenal ulcers. Ann Surg 249(2):189–194

    Article  PubMed  Google Scholar 

  15. Kojima K, Yamada H, Inokuchi M, Kawano T, Sugihara K (2008) A comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg 247(6):962–967

    Article  PubMed  Google Scholar 

  16. Kim MC, Jung GJ, Kim HH (2005) Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol 11(47):7508–7511

    PubMed  Google Scholar 

  17. Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG (2002) AJCC cancer staging manual, 6th edn. Springer, New York

    Book  Google Scholar 

  18. Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma, 2nd English ed. Gastric Cancer 1:10–24

    Article  PubMed  Google Scholar 

  19. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  Google Scholar 

  20. Kim MC, Kim W, Kim HH, Ryu SW, Ryu SY, Song KY, Lee HJ, Cho GS, Han SU, Hyung WJ, Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group (2008) Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale Korean multicenter study. Ann Surg Oncol 15(10):2692–2700

    Article  PubMed  Google Scholar 

  21. Kim W, Song KY, Lee HJ, Han SU, Hyung WJ, Cho GS (2008) The impact of comorbidity on surgical outcomes in laparoscopy-assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg 248(5):793–799

    Article  PubMed  Google Scholar 

  22. The Information Committee of the Korean Gastric Cancer Association (2007) 2004 Nationwide Gastric Cancer Report in Korea. J Korean Gastric Cancer Assoc 7(1):47–54

    Google Scholar 

  23. Kim BJ, O’Connell T (1999) Gastroduodenostomy after gastric resection for cancer. Am Surg 65(10):905–907

    PubMed  CAS  Google Scholar 

  24. Lee WJ, Wang W, Chen TC, Chen JC, Ser KH (2008) Totally laparoscopic radical BII gastrectomy for the treatment of gastric cancer: a comparison with open surgery. Surg Laparosc Endosc Percutan Tech 18(4):369–374

    Article  PubMed  CAS  Google Scholar 

  25. Kyzer S, Binyamini Y, Melki Y, Ohana G, Koren R, Chaimoff C, Wolloch Y (1997) Comparative study of the early postoperative course and complications in patients undergoing Billroth I and Billroth II gastrectomy. World J Surg 21(7):763–766

    Article  PubMed  CAS  Google Scholar 

  26. Lee HJ, Kim HH, Kim MC, Ryu SY, Kim W, Song KY, Cho GS, Han SU, Hyung WJ, Ryu SW, Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group (2009) The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer. Surg Endosc 23(11):2473–2479

    Article  PubMed  Google Scholar 

  27. Hyung WJ, Song C, Cheong JH, Choi SH, Noh SH (2007) Factors influencing operation time of laparoscopy-assisted distal subtotal gastrectomy: analysis of consecutive 100 initial cases. Eur J Surg Oncol 33(3):314–319

    Article  PubMed  CAS  Google Scholar 

  28. Wang HT, Lu QC, Wang Q, Wang RC, Zhang Y, Chen HL, Zhao H, Qian HX (2008) Role of the duodenum in regulation of plasma ghrelin levels and body mass index after subtotal gastrectomy. World J Gastroenterol 14(15):2425–2429

    Article  PubMed  CAS  Google Scholar 

  29. Ledeboer M, Masclee AA, Biemond I, Lamers CB (1998) Effect of intragastric or intraduodenal administration of a polymeric diet on gallbladder motility, small-bowel transit time, and hormone release. Am J Gastroenterol 93(11):2089–2096

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosures

Drs. Kyu-Chul Kang, Gyu Seok Cho, Sang Uk Han, Wook Kim, Hyung-Ho Kim, Min-Chan Kim, Woo Jin Hyung, Seong Yeob Ryu, Seung Wan Ryu, Hyuk Joon Lee, and Kyo Young Song have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Soonchunhyang University Bucheon Hospital, 1174, Jung-dong, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-767, Korea

    Kyu-Chul Kang & Gyu Seok Cho

  2. Department of Surgery, Ajou University Hospital, Suwon, Korea

    Sang Uk Han

  3. Department of Surgery, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea

    Wook Kim

  4. Department of Surgery, Bundang Hospital, Seoul National University, Seongnam, Korea

    Hyung-Ho Kim

  5. Department of Surgery, Dong-A University College of Medicine, Busan, Korea

    Min-Chan Kim

  6. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea

    Woo Jin Hyung

  7. Department of Surgery, Chonnam National University College of Medicine, Gwangju, Korea

    Seong Yeob Ryu

  8. Department of Surgery, Keimyung University College of Medicine, Daegu, Korea

    Seung Wan Ryu

  9. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

    Hyuk Joon Lee

  10. Department of Surgery, The Catholic University of Korea, Seoul, Korea

    Kyo Young Song

Authors
  1. Kyu-Chul Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gyu Seok Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sang Uk Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wook Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hyung-Ho Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Min-Chan Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Woo Jin Hyung
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Seong Yeob Ryu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Seung Wan Ryu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hyuk Joon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kyo Young Song
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group

Corresponding author

Correspondence to Gyu Seok Cho.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kang, KC., Cho, G.S., Han, S.U. et al. Comparison of Billroth I and Billroth II reconstructions after laparoscopy-assisted distal gastrectomy: a retrospective analysis of large-scale multicenter results from Korea. Surg Endosc 25, 1953–1961 (2011). https://doi.org/10.1007/s00464-010-1493-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-010-1493-0

Keywords

Search

Navigation