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

• Published in: Journal of gastrointestinal surgery 2016-04, Vol.20 (4), p.772-775
• Main Authors: Hoya, Yoshiyuki, Taki, Tetsuya, Watanabe, Atsushi, Nakayoshi, Tomoko, Okamoto, Tomoyoshi, Mitsumori, Norio, Yanaga, Katsuhiko
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Dumping syndrome; Dumping Syndrome - etiology; Dumping Syndrome - prevention & control; Duodenogastric Reflux - etiology; Duodenogastric Reflux - prevention & control; Endoscopy; Female; Follow-Up Studies; Gastrectomy - adverse effects; Gastrectomy - methods; Gastric cancer; Gastric Stump - surgery; Gastritis - etiology; Gastritis - prevention & control; Gastroenterology; Gastroenterostomy - adverse effects; Gastroenterostomy - methods; Gastrointestinal surgery; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Pylorus - surgery; Stomach Neoplasms - surgery; Surgery; Time Factors; Weight Loss
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-015-3022-x

Background We have reported the short-term results of pylorus reconstruction gastrectomy (PRG) that prevents duodenogastric reflux (DGR) and remnant gastritis after distal gastrectomy. We herein report the long-term results of the PRG. Patients and Methods PRG was performed in 37 patients (age 31 to 86 [mean 67.8 ± 12.3] years, male:female = 22:15) with gastric cancer from June 2006 through December 2013. We examined the long-term outcome in 28 patients (age 41 to 86 [mean 67.0 ± 10.7] years, male:female = 18:10) that passed over 3 years after surgery (LTR 44.1 ± 11.7 months), and compared with their short-term result after the operation (STR 13.1 ± 6.9 months). The adverse events of gastric surgery evaluated in this study consisted of the degree of remnant gastritis, the presence of dumping syndrome, and degree of weight loss (%). Results There was no difference in the degree of DGR and remnant gastritis by gastroscopic finding between LTR and STR after PRG ( P  = 0.21). Statistically, there was no difference in the bile acid concentration of remnant gastric juice between LTR and STR (108.4 ± 254.1 vs. 94.0 ± 208.6 μmol/L, P  = 0.33), and weight loss of LTR was the same as that of STR (5.67 ± 7.08 vs. 4.59 ± 5.63 %, P  = 0.34). There were few morphological changes in the reconstructed pylorus by the long-term course, but 2 patients showed mild atrophy. Conclusion The form of reconstructed pylorus and the effect that reduces side effects of Billroth I seem to last for a long time.