Skip to main content
SpringerLink
Log in

Usefulness of Pyloric Reconstruction Without Compromising Curative Resection in Gastric Cancer Treatment

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

We herein report the short-term results of the newly developed modified technique of Billroth I (modified B-I; pylorus reconstruction) that prevents duodenogastric reflux (DGR) and remnant gastritis after distal gastrectomy.

Patients and Methods

Distal gastrectomy with this technique was performed in 20 patients (age, 41 to 86 years [mean, 68.5 ± 11.8 years], male/female = 12:8) with gastric cancer from June 2006 through December 2009. These patients were compared with another 20 patients who underwent conventional B-I after distal gastrectomy (age, 41 to 85 years [mean, 69.3 ± 8.69 years], male/female = 11:9). The side effects of gastric surgery evaluated in this study were the degree of remnant gastritis, the presence of dumping syndrome, and the degree of weight loss.

Results

By gastrografin contrast imaging on the fifth day after pylorus reconstruction, the remnant stomach was not dilated and gastrografin flowed physiologically to the duodenum without backward reflux into the remnant stomach. By gastroscopy at 6 months after the operation, DGR and the degree of remnant gastritis after pylorus reconstruction was lower than those of conventional B-I (P = 0.00068). The bile acid concentration of remnant gastric juice of pylorus reconstruction was lower than that of conventional B-I (55.5 ± 93.5 vs. 1,369.5 ± 2,502.1 μmol/L, P = 0.0415). Weight loss at 1 year after distal gastrectomy was less in pylorus reconstruction compared with conventional B-I (6.2 ± 5.2% vs. 9.8 ± 8.7%, P = 0.0725).

Conclusion

Pylorus reconstruction is a simple and safe anastomotic technique that reduces the side effects of B-I 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

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Osugi H, Fukuhara K, Takada N, Takemura M, Kinoshita H. Reconstructive procedure after distal gastrectomy to prevent remnant gastritis. Hepatogastroenterology 2004;51:1215–8.

    PubMed  CAS  Google Scholar 

  2. Fukuhara K, Osugi H, Takada N, Takemura M, Higashino M, Kinoshita H. Reconstructive procedure after distal gastrectomy for gastric cancer that best prevents duodenogastroesophageal reflux.World J Surg 2002;26:1452–7.

    Article  PubMed  Google Scholar 

  3. Shinoto K, Ochiai T, Suzuki T, Okazumi S, Ozaki M. Effectiveness of Roux-en-Y reconstruction after distal gastrectomy based on an assessment of biliary kinetics. Surg Today 2003;33:169–77

    Article  PubMed  Google Scholar 

  4. Hedberg J, Hedenstrom H, Nilsson S, Sundbom M, Gustavsson S. Role of gastric acid in stomal ulcer after gastric bypass. Obes Surg 2005;15:1375–8.

    Article  PubMed  Google Scholar 

  5. Kodama I, Yoshida C, Kofuji K, Ohta J, Aoyagi K, Takeda J. Gallstones and gallbladder disorder after gastrectomy for gastric cancer. Int Surg 1996;81:36–9.

    PubMed  CAS  Google Scholar 

  6. Kobayashi T, Hisanaga M, Kanehiro H, Yamada Y, Ko S, Nakajima Y. Analysis of risk factors for the development of gallstones after gastrectomy. Br J Surg 2005;92:1399–403

    Article  PubMed  CAS  Google Scholar 

  7. Gustavsson S, Ilstrup DM, Morrison P, Kelly KA. Roux-Y stasis syndrome after gastrectomy. Am J Surg 1988;155:490–4.

    Article  PubMed  CAS  Google Scholar 

  8. Cozzaglio L, Coladonato M, Dagrada CT, Doci R, Gennari L. Does the Roux-en-Y-stasis syndrome still exist? Chir Ital 2005;57:27–34.

    PubMed  Google Scholar 

  9. Takahashi T, Yoshida M, Kubota T, Otani Y, Saikawa Y, Ishikawa H, Suganuma K, Akatsu Y, Kumai K, Kitajima M. Morphologic analysis of gastroesophageal reflux diseases in patients after distal gastrectomy. World J Surg 2005;29:50–7.

    Article  PubMed  Google Scholar 

  10. Takeno S, Noguchi T, Kimura Y, Fujiwara S, Kubo N, Kawahara K. Early and late gastric cancer arising in the remnant stomach after distal gastrectomy. Eur J Surg Oncol 2006;32:1191–4.

    Article  PubMed  CAS  Google Scholar 

  11. Hoya Y, Mitsumori N, Yanaga K. The advantages and disadvantages of a Roux-en-Y reconstruction after a distal gastrectomy for gastric cancer. Surg Today 2009;39:647–51.

    Article  PubMed  Google Scholar 

  12. Ovaska JT, Ekfors TO, Luukkonen PE, Lempinen MJ. Histological changes in the gastric stump mucosa and late clinical results after Billroth I, Billroth II and Roux-en-Y operations for peptic ulcer disease. Ann Chir Gynaecol 1988;77:1–5.

    PubMed  CAS  Google Scholar 

  13. Hoya Y. Modified Billroth I after distal gastrectomy for prevention of remnant gastritis? The feasibility report (Billroth I evolved in year 120). Surgery 2007; 142: 427–8.

    Article  PubMed  Google Scholar 

  14. Hoya Y, Taki T, Hoshino M, Shida A, Kohno S, Okamoto T, Yanaga K. Modified Billroth-I reconstruction after distal gastrectomy. Gastric Cancer 2009; 12: 54–5.

    Article  PubMed  Google Scholar 

  15. Nakane Y, Akehira K, Inoue K, Iiyama H, Sato M, Masuya Y, Okumura S, Yamamichi K, Hioki K. Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer. Hepatogastroenterology 2000;47:590–5.

    PubMed  CAS  Google Scholar 

  16. Nomura E, Isozaki H, Fujii K, Toyoda M, Niki M, Sako S, Mabuchi H, Nishiguchi K, Tanigawa N. Postoperative evaluation of function-preserving gastrectomy for early gastric cancer. Hepatogastroenterology 2003;50:2246–50.

    PubMed  Google Scholar 

  17. Morii Y, Arita T, Shimoda K, Yasuda K, Matsui Y, Inomata M, Kitano S. Jejunal interposition to prevent postgastrectomy syndromes. Br J Surg 2000;87:1576–9.

    Article  PubMed  CAS  Google Scholar 

  18. Nakane Y, Michiura T, Inoue K, Habara K, Nakai K, Sato M, Okumura S, Yamamichi K. Jejunal interposition helps prevent reflux gastritis. Hepatogastroenterology 2002;49:1461–4.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Daisan Hospital, The Jikei University School of Medicine, 4-11-1, Izumihon-cho, Komae-si, Tokyo, 201-8601, Japan

    Yoshiyuki Hoya, Tetsuya Taki, Yujirou Tanaka, Masato Hoshino & Tomoyoshi Okamoto

  2. Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Hideyuki Kashiwagi & Katsuhiko Yanaga

Authors
  1. Yoshiyuki Hoya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tetsuya Taki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yujirou Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masato Hoshino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomoyoshi Okamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hideyuki Kashiwagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Katsuhiko Yanaga
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshiyuki Hoya.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hoya, Y., Taki, T., Tanaka, Y. et al. Usefulness of Pyloric Reconstruction Without Compromising Curative Resection in Gastric Cancer Treatment. J Gastrointest Surg 16, 1102–1106 (2012). https://doi.org/10.1007/s11605-012-1850-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-012-1850-5

Keywords

Search

Navigation