Effectiveness of Roux-en-Y Reconstruction After Distal Gastrectomy Based on an Assessment of Biliary Kinetics

Shinoto, Koichi; Ochiai, Takenori; Suzuki, Takao; Okazumi, Shinichi; Ozaki, Masahiko

doi:10.1007/s005950300039

Cited by 45 publications

(53 citation statements)

References 17 publications

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“…We previously evaluated short-term outcomes after LDG and reported several advantages of R-Y over B-I, consistent with the results of the present study [15]. Previous studies of short-term outcomes have shown that R-Y reconstruction, compared with B-I, is associated with lower incidences of gastroesophageal reflux, bile reflux, and remnant gastritis on endoscopic examination [12,[20][21][22]. Gastroesophageal reflux, as assessed by dynamic scintiscan, is also less frequent after R-Y than after B-I [23].…”

Section: Discussionsupporting

confidence: 88%

“…Less gastroesophageal and duodenogastric reflux might underlie the lower incidence of symptoms after R-Y. In other studies [12,21], the proportions of patients with clinical symptoms caused by these types of reflux ranged from 0 to 17 % after R-Y, as compared with 12-63 % after B-I 3-6 months after operation. The incidence of heartburn was lower after R-Y (10 %) than after B-I (37 %) 1 year postoperatively in our previous study [15].…”

Section: Discussionmentioning

confidence: 74%

“…Gastroesophageal reflux, as assessed by dynamic scintiscan, is also less frequent after R-Y than after B-I [23]. In addition, bile reflux on bilirubin monitoring and biliary scintigraphy is mild after R-Y [12,21]. Less gastroesophageal and duodenogastric reflux might underlie the lower incidence of symptoms after R-Y.…”

Section: Discussionmentioning

confidence: 99%

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Long-term outcomes of Roux-en-Y and Billroth-I reconstruction after laparoscopic distal gastrectomy

et al. 2012

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Background Laparoscopic distal gastrectomy (LDG) is an established procedure for the treatment of early gastric cancer. Roux-en-Y (R-Y) or Billroth-I (B-I) reconstruction is generally performed after LDG in Japan. The aim of this retrospective cohort study was to compare the effectiveness of R-Y and B-I reconstructions and thereby determine which has better clinical outcomes. Methods We analyzed data from 172 patients with gastric cancer who underwent LDG. Reconstruction was done by R-Y in 83 patients and B-I in 89. All patients were followed up for 5 years. Evaluated variables included symptoms, nutritional status, endoscopic findings, gallstone formation, and later gastrointestinal complications. Results Scores for the amount of residue in the gastric stump, remnant gastritis, and bile reflux, calculated according to the ''residue, gastritis, bile'' scoring system, were significantly lower in the R-Y group (score 0 vs. 1 and more; p = 0.027, \0.001, and \0.001, respectively). The proportion of patients with reflux esophagitis was significantly lower in the R-Y group (p \ 0.001). Relative values (postoperative 5 years/preoperative) for body weight, serum albumin level, and total cholesterol level were similar in the two groups (p = 0.59, 0.56, and 0.34, respectively). Gallstone formation did not differ between the groups (p = 0.57). As for later complications, the incidence of gastrointestinal ulcer was 4.5 % in the B-I group, and that of ileus was 3.6 % in the R-Y group, but differences between the groups were not significant (p = 0.12, 0.11, respectively). Conclusions As compared with B-I, R-Y was associated with lower long-term incidences of both bile reflux into the gastric remnant and reflux esophagitis.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 74%

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Long-term outcomes of Roux-en-Y and Billroth-I reconstruction after laparoscopic distal gastrectomy

et al. 2012

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“…One incident of Barrett's esophagus in a patient in the B-II with Braun anastomosis group was observed 12 months postoperatively. Shinoto et al [13] also reported that bile reflux in the remnant stomach was significantly less in the R-Y group than in the B-I and B-II groups based on biliary scintigraphy. In our study, the extent of bile reflux in the B-I group was also less but not significantly different from that in the B-II group at 12 months.…”

Section: Discussionmentioning

confidence: 94%

What is the best reconstruction method after distal gastrectomy for gastric cancer?

et al. 2011

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“…Moreover, B-I reconstruction has the physiological advantage of permitting the passage of food through the duodenum [16]. However, compared to B-I reconstruction, R-Y reconstruction also has certain advantages, such as a reduction in the incidence of anastomotic leakage and prevention of remnant gastritis and bile reflux into the remnant stomach [7,8,[17][18][19][20][21]. Hence, R-Y reconstruction after LADG has been the firstchoice reconstruction technique at our institution since March 2003.…”

Section: Discussionmentioning

confidence: 99%

β-Shaped intracorporeal Roux-en-Y reconstruction after totally laparoscopic distal gastrectomy

et al. 2013

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Background The use of laparoscopic gastrectomy for the treatment of gastric cancer has been increasing. Roux-en-Y (R-Y) reconstruction after laparoscopy-assisted distal gastrectomy is now widely used to decrease leakage and prevent reflux. Owing to the need for a less invasive technique, we have developed a new technique for intracorporeal R-Y reconstruction (b reconstruction) after totally laparoscopic distal gastrectomy (TLDG). Methods In this report, we describe the b reconstruction technique and short-term outcomes of the initial 105 patients who underwent b reconstruction from December 2008 to March 2012. Results The operative and b reconstruction times were 330 ± 61.3 and 29 ± 5.6 min (mean ± SD), respectively. Anastomotic leakage after gastrojejunostomy occurred in one patient (0.9 %), requiring reoperation. Four cases (3.8 %) of anastomotic stenosis required endoscopic balloon dilation. However, R-Y stasis was not noted. ConclusionsWe have indicated a technical description as well as the usefulness of b-shaped intracorporeal R-Y reconstruction after TLDG.

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Effectiveness of Roux-en-Y Reconstruction After Distal Gastrectomy Based on an Assessment of Biliary Kinetics

Abstract: In this series, RY was found to be a superior reconstruction method after distal gastrectomy since it was rarely accompanied by the reflux of duodenal juice into the remnant stomach or gastric reflux into the lower esophagus.

Cited by 45 publications

References 17 publications

Long-term outcomes of Roux-en-Y and Billroth-I reconstruction after laparoscopic distal gastrectomy

Long-term outcomes of Roux-en-Y and Billroth-I reconstruction after laparoscopic distal gastrectomy

What is the best reconstruction method after distal gastrectomy for gastric cancer?

β-Shaped intracorporeal Roux-en-Y reconstruction after totally laparoscopic distal gastrectomy

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