J Gastric Cancer.  2015 Mar;15(1):46-52. 10.5230/jgc.2015.15.1.46.

A Comparison of Outcomes of Three Reconstruction Methods after Laparoscopic Distal Gastrectomy

• Kim CH
• Song KY
• Park CH
• Seo YJ
• Park SM
• Kim JJ

• KMID: 2372370
• DOI: http://doi.org/10.5230/jgc.2015.15.1.46

Abstract

PURPOSE
The aim of this study was to compare the short-term surgical and long-term functional outcomes of Billroth I, Billroth II, and Roux-en-Y reconstruction after laparoscopic distal gastrectomy.
MATERIALS AND METHODS
We retrospectively collected data from 697 patients who underwent laparoscopic distal gastrectomy for operable gastric cancer between January 2009 and December 2012. The patients were classified into three groups according to the reconstruction methods: Billroth I, Billroth II, and Roux-en-Y. The parameters evaluated included patient and tumor characteristics, operative details, and postoperative complications classified according to the Clavien-Dindo classification. Endoscopic findings of the remnant stomach were evaluated according to the residue, gastritis, bile (RGB) classification and the Los Angeles classification 1 year postoperatively.
RESULTS
Billroth I, Billroth II, and Roux-en-Y were performed in 165 (23.7%), 371 (53.2%), and 161 patients (23.1%), respectively. Operation time was significantly shorter (173.4+/-44.7 minute, P<0.001) as was time to first flatus (2.8+/-0.8 days, P=0.009), time to first soft diet was significantly faster (4.3+/-1.0 days, P<0.001), and postoperative hospital stay was significantly shorter (7.7+/-4.0 days, P=0.004) in Billroth I in comparison to the other methods. Postoperative complications higher than Clavien-Dindo grade III occurred in 61 patients (8.8%) with no statistically significant differences between groups (P=0.797). Endoscopic findings confirmed that gastric residue, gastritis, bile reflux, and reflux esophagitis were significantly lower in Roux-en-Y (P<0.001) patients.
CONCLUSIONS
Roux-en-Y reconstruction after laparoscopic distal gastrectomy for middle-third gastric cancer is beneficial in terms of long-term functional outcome, whereas Billroth I reconstruction for distal-third gastric cancer has a superior short-term surgical outcome and postoperative weight change.

Keyword

Gastrectomy; Surgical anastomosis; Laparoscopy; Stomach neoplasms

MeSH Terms

Anastomosis, Surgical
Bile
Bile Reflux
Classification
Diet
Esophagitis, Peptic
Flatulence
Gastrectomy*
Gastric Stump
Gastritis
Gastroenterostomy
Humans
Laparoscopy
Length of Stay
Postoperative Complications
Retrospective Studies
Stomach Neoplasms

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