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

Abstract

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

Durable Flap-Valve Mitigation of Duodenogastric Reflux, Remnant Gastritis and Dumping Syndrome Following Billroth I Reconstruction

“…The preferable reconstruction procedure after distal gastrectomy should minimize postoperative complication and improve quality of life. [13][14][15] In current scene of surgical treatment, B-I and R-Y are the most popular reconstruction procedures after distal gastrectomy. 16 To the best of our knowledge, B-I is commonly selected after distal gastrectomy for gastric cancer, because of its simplicity, physiological advantage of food passing through the duodenum, and ease of postoperative endoscopy accessing to the papilla of Vater.…”

International consensus on the diagnosis and management of dumping syndrome

“…Furthermore, all of these questionnaires are thought to lack sensitivity to treatment interventions, indicating the need for a specific patient-reported outcome questionnaire to be developed for dumping syndrome. There is agreement that the modified OGTT is the preferred diagnostic method (statement 33), and diagnostic parameters for early and late dumping syndrome are well established (statements [34][35][36]. The same glycaemia level cut-off (50 mg/dl) is proposed for spontaneous glycaemia levels and for late hypoglycaemia during the modified OGTT for supporting the diagnosis of dumping syndrome (statements 28, 29, 35 and 36).…”

“…However, literature from the peptic ulcer surgery era and data from gastric and oesophageal cancer surgery around the turn of the century also show that dumping syndrome might lead to weight loss 29,30 . In addition, procedures that aim to prevent dumping syndrome such as vagus sparing oesophagectomy or pyloric reconstruction with gastric cancer surgery are associated with less weight loss than traditional resection procedures 19,[31][32][33][34][35] . Weight loss was also reported in adults and children with dumping syndrome after Nissen fundoplication 13,21,36 .…”

Gastric Emptying Improved Significantly After PRG Compared to Billroth-I Reconstruction: Assessment of Gastric Emptying With a 13C-Breath Test

“…We found the degree of remnant gastritis after PRG was lower than that associated with conventional B-I, and the acid concentration after PPG was lower than that after B-I (3,4). Moreover, the proximal side of the modified B-I anastomosis had the appearance of a reconstructed pylorus, and the inverted gastric mucosa was similar to a distal flap-valve (3,4).…”