Comparison of the Physiological Effect of Billroth-I and Roux-en-Y Reconstruction Following Laparoscopic Distal Gastrectomy.

Abstract

BACKGROUND:

Laparoscopic distal gastrectomy (LDG) is a widely used minimally invasive surgery. Following LDG, Billroth-I (B-I) provides physiological reconstruction by preserving the duodenal passage but results in a high incidence of reflux esophagitis that decreases postoperative quality of life. Because of this, Roux-en-Y (R-Y) reconstruction is often considered the first choice after LDG. However, very few studies have investigated differences in physiological function between B-I and R-Y after LDG. We hypothesized that B-I would outperform R-Y in clinical and physiological outcomes, including nutrition parameters.

METHODS:

We compared hemoglobin, ferritin, serum iron, Vitamin B12, 25(OH)-Vitamin D (V-D), body weight, and gastric emptying after LDG in patients with either B-I or R-Y reconstruction.

RESULTS:

The levels of hemoglobin in the B-I group were significantly higher than that in the R-Y group at all time points later than 6 months postsurgery. The ferritin levels were significantly higher in the B-I group at all time points later than 9 months postsurgery. The concentration of serum V-D in the B-I group was significantly higher than that in the R-Y group at 1 year 6 months, 1 year 9 months, and 2 years after surgery. Gastric emptying in the R-Y group was significantly slower than in the B-I group.

CONCLUSIONS:

Our data indicate that B-I leads to less postsurgical iron deficiency anemia and V-D deficiency compared with R-Y reconstruction. Furthermore, gastric emptying was preserved in B-I reconstruction compared with R-Y reconstruction. In conclusion, after LDG, B-I reconstruction seems to cause fewer nutritional complications than R-Y reconstruction.

• Authors: Yoshitaka Toyomasu, Kyoichi Ogata, Masaki Suzuki, Toru Yanoma, Akiharu Kimura, Norimichi Kogure, Tetsuro Ohno, Yoichi Kamiyama, Erito Mochiki, Hiroyuki Kuwano
• Journal: Surgical laparoscopy, endoscopy & percutaneous techniques (Surg Laparosc Endosc Percutan Tech) Vol. 28 Issue 5 Pg. 328-333 (Oct 2018) ISSN: 1534-4908 [Electronic] United States
• PMID: 30180143 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Hemoglobins
• Vitamin D
• Ferritins
• Vitamin B 12

Topics

• Aged
• Anastomosis, Roux-en-Y (methods)
• Case-Control Studies
• Female
• Ferritins (metabolism)
• Gastrectomy (methods)
• Gastric Emptying (physiology)
• Gastroenterostomy (methods)
• Hemoglobins (metabolism)
• Humans
• Laparoscopy (methods)
• Male
• Middle Aged
• Nutritional Status
• Reoperation
• Retrospective Studies
• Stomach Neoplasms (physiopathology, surgery)
• Treatment Outcome
• Vitamin B 12 (metabolism)
• Vitamin D (metabolism)