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Reconstructive procedure after distal gastrectomy for gastric cancer that best prevents duodenogastroesophageal reflux

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Abstract

Billroth I and II reconstructions are commonly performed after distal gastrectomy. Both may cause duodenogastric and duodenogastro-esophageal reflux, conditions reported to have carcinogenetic potential. The aim of this study was to investigate which reconstructive procedure would most effectively prevent bile reflux into the gastric remnant and esophagus after distal gastrectomy. A group of 92 patients who underwent curative distal gastrectomy for gastric cancer were subjected and classified into three groups retrospectively by the reconstructive procedure undertaken: group A, Roux-en-Y (Roux-Y) reconstruction (n=29); group B, Billroth I reconstruction (n=41); group C, Billroth II reconstruction (n=22). The bile reflux periods (percent time) for the gastric remnant and esophagus were measured with the Bilitec 2000 under standardized conditions. The percent time for the gastric remnant was significantly less in group A than in group B or C. In 61% of all patients, bile reflux into the esophagus was found to be more than 5.0% of the time; it was less in group A than in group B or C (p=0.057). A questionnaire revealed a good correlation between the incidence of reflux symptoms and the percent time for the gastric remnant and esophagus. Roux-Y reconstruction is superior to either Billroth I or II reconstruction for preventing bile reflux into the gastric remnant and esophagus after distal gastrectomy.

Résumé

Le rétablissement de continuité après gastrectomie distale est habituellement selon Billroth I ou selon Billroth II. Cependant, les deux types de reconstruction peuvent être responsables de reflux duodénogastrique et de reflux duodénogastroesophagien, avec un risque plus élevé de développer un cancer. Le but de cette étude a été de déterminer quel type de rétablissement serait le plus efficient dans la prévention du reflux de bile dans le moignon gastrique et dans l’œsophage après gastrectomie distale. Quatre-vingt-deux patients qui ont eu une gastrectomie distale à visée curatrice pour cancer ont été inclus et classés rétrospectivement en trois groupes selon le type de reconstruction: groupe A, reconstruction par anse en Y (n=29); groupe B, rétablissement de continuité selon Billroth I (n=41); et groupe C, rétablissement selon Billroth II (n=22). La durée du reflux (en pourcentage de temps) au niveau du moignon gastrique et de l’œsophage a été mesurée dans des conditions standardisées Bilitec 2000. Le pourcentage de temps pour le moignon gastrique a été signifieativement plus bas dans le groupe A que dans les groupes B et C. La durée du reflux de bile dans l’œsophage a dépassé 5% chez 61% des patients: elle a été moins longue dans le groupe I que dans les groupes B et C (p=0.057). Grâce à un questionnaire on a pu trouver une bonne corrélation entre l’incidence des symptômes de reflux et la durée du temps de reflux dans le moignon gastrique et dans l’œsophage. Le rétablissement de continuité par anse en Y est supérieur aux rétablissements de types Billroth I et II en ce qui concerne la prévention de reflux de bile dans le moignon gastrique et dans l’œsophage après gastrectomie distale.

Resumen

Las reconstrucciones tipos Billroth I y II son las más comunes cuando se practica una gastrectomía. Sin embargo, ambas pueden causar reflujo duodenogástrico y duodeno gastroesofágico, fenómeno que se reconocen como de potencial efecto carcinogenético. El propósito del presente estudio fue investigar cuál procedimiento de reconstrucción podría prevenir el reflujo al remanente gástrico y al esófago luego de una gastrectomía distal. Noventa y dos pacientes sometidos a gastrectomía distal curativa por cáncer fueron clasificados retrospectivamente en 3 grupos: grupo A, reconstrucción de Roux-en-Y (n=29); grupo B, reconstrucción Billroth I (n=41); grupo C, reconstrucción Billroth II (n=22). El periodo de reflujo biliar (por ciento del tiempo) al estómago residual y al esófago fue determinado mediante Bilitec 2000 bajo condiciones estandarizadas. El porcentaje de tiempo para el estómago residual fue significativamente menor en el grupo A en comparación con los grupos B y C. En 61% de la totalidad de los pacientes se encontró reflujo al esófago por más del 5% del tiempo; fue menor en el grupo A que en los grupos B y C (p=0.057). La aplicación de un cuestionario reveló buena correlación entre la incidencia de los síntomas de reflujo y el porcentaje de tiempo del reflujo al remanente gástrico y al esófago. La reconstrucción de Roux-en-Y es superior a las reconstrucciones Billroth I y II en cuanto a la prevención del reflujo biliar al remanente gástrico y al esófago luego de una gastrectomía distal.

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Authors and Affiliations

  1. Second Department of Surgery, Osaka City University Medical School, 1-4-3 Asahimachi Abeno-ku, 545-8586, Osaka, Japan

    Kenichiro Fukuhara M.D., Harushi Osugi M.D., Nobuyasu Takada M.D., Masashi Takemura M.D., Masayuki Higashino M.D. & Hiroaki Kinoshita M.D.

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  1. Kenichiro Fukuhara M.D.
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  2. Harushi Osugi M.D.
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  3. Nobuyasu Takada M.D.
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  4. Masashi Takemura M.D.
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  5. Masayuki Higashino M.D.
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  6. Hiroaki Kinoshita M.D.
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Published Online: October 10, 2002

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Fukuhara, K., Osugi, H., Takada, N. et al. Reconstructive procedure after distal gastrectomy for gastric cancer that best prevents duodenogastroesophageal reflux. World J. Surg. 26, 1452–1457 (2002). https://doi.org/10.1007/s00268-002-6363-z

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  • DOI: https://doi.org/10.1007/s00268-002-6363-z

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