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billroth ii anastomosis combined with brown anastomosis reduce reflux gastritis in gastric cancer patients

World Journal of Methodology 2024年第1期14卷 71-79页

作者： Grigorios Christodoulidis Marina Nektaria Kouliou Konstantinos Eleftherios Koumarelas Konstantinos Argyriou Garyfallia Apostolia Karali Konstantinos Tepetes Department of General Surgery University Hospital of LarissaLarissa 41110Greece Department of Gastroenterology University Hospital of LarissaLarissa 41334Greece

BACKGROUND The surgeon performing a distal gastrectomy,has an arsenal of reconstruction techniques at his disposal,billroth ii among them.Braun anastomosis performed during a billroth ii procedure has shown evidence of superiority over typical billroth ii,in terms of survival,with no impact on postoperative morbidity and mortality.AIM To compare billroth ii vs billroth ii and Braun following distal gastrectomy,regarding their postoperative course.METHODS Patients who underwent distal gastrectomy during 2002-2021,were separated into two groups,depending on the surgical technique used(billroth ii:74 patients and billroth ii and Braun:28 patients).The daily output of the nasogastric tube(NGT),the postoperative day that NGT was removed and the day the patient started per os feeding were recorded.Postoperative complications were at the same time noted.Data were then statistically analyzed.RESULTS There was difference in the mean NGT removal day and the mean start feeding day.Mean total postoperative NGT output was lower in Braun group(399.17 mL vs 1102.78 mL)and it was statistically significant(Pbillroth ii group,while 9 patients who underwent Christodoulidis G et al.billroth ii and Braun compared with billroth ii WJM https://*** 2 March 20,2024 Volume 14 Issue 1 billroth ii and Braun anastomosis were presented with the same conditions(Pbillroth ii and Braun vs typical billroth ii in terms of bile reflux,alkaline gastritis and NGT output.

关键词： billroth ii billroth ii and Braun Reconstruction techniques Gastrectomy Distal gastrectomy

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World Journal of Gastroenterology 2021年第16期27卷 1816-1827页

作者： Jan Grosek Hana Zavrtanik AlešTomažič Department of Abdominal Surgery University Medical Centre LjubljanaLjubljana 1000Slovenia Medical Faculty University of LjubljanaLjubljana 1000Slovenia

BACKGROUND With improved survival in gastric cancer patients,health-related quality of life has become an important clinical endpoint alongside primary oncological outcomes.AIM To investigate health-related quality of life after various surgical procedures for gastric cancer treatment.METHODS The validated Slovenian version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire(QLQ-C30)and its gastric cancer-specific module(QLQ STO-22)was sent for self-completion to patients that underwent curative resection for gastric adenocarcinoma between January 2014 and December 2018 at our centre.In total,116 patients responded.Scores were compared between patients after subtotal distal vs total gastrectomy and patients after subtotal distal gastrectomy with billroth ii vs Roux-en-Y reconstruction.RESULTS Interestingly,the extent of resection did not influence daily functioning;however,more dysphagia and eating restrictions were reported in patients after total gastrectomy when compared to patients after subtotal distal gastrectomy.Moreover,patients with billroth ii reconstruction after subtotal distal resection experienced worse physical and role functioning and reported more pain,fatigue and reflux compared to Roux-en-Y reconstruction.CONCLUSION Based on our results,Roux-en-Y reconstruction after subtotal distal gastrectomy should be preferred over billroth ii reconstruction.The data obtained from this study will help surgeons when preoperatively informing their patients about expected functional outcomes after gastrectomy and enable them to ensure proper supportive care of their patients in the postoperative period.

关键词： Gastric cancer Quality of life Roux-en-Y billroth ii Gastrectomy

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Mixed neuroendocrine carcinoma of the gastric stump: A case report

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World Journal of Clinical Cases 2021年第27期9卷 8090-8096页

作者： Hui Zhu Ming-Yuan Zhang Wei-Liang Sun Gun Chen Gastrointestinal Surgery Department The Affiliated People's Hospital of Ningbo UniversityNingbo 315000Zhejiang ProvinceChina Pathologic Department The Affiliated People's Hospital of Ningbo UniversityNingbo 315000Zhejiang ProvinceChina

BACKGROUND Gastric stump cancer,also known as gastric remnant cancer(GRC),is one of the main complications of postgastrectomy syndrome,which usually occurs following billroth ii reconstruction.The predominant histological subtype of GRC is adenocarcinoma,whereas neuroendocrine carcinoma is relatively rare.In particular,there are few recently reported cases of mixed neuroendocrine carcinoma(MNEC)in the English literature.Here,we present an extremely rare case of MNEC of the gastric stump.CASE SUMMARY A 59-year-old patient presented to our department owing to chronic constipation.He had undergone subtotal gastric resection 35 years prior to admission because of benign peptic ulcer.After admission,the patient underwent several tests,and gastroendoscopy showed evidence of billroth ii gastrectomy and local thickening of the gastric stump mucosa at the gastrojejunostomy site,with bile reflux;pathological biopsy revealed adenocarcinoma.He was then diagnosed with GRC and underwent total gastrectomy,D2 Lymphadenectomy,and esophagojejunal Roux-en-Y reconstruction.Histopathological examination of the specimen identified MNEC comprising MNEC(60%),adenocarcinoma(30%),and squamous cell carcinoma(10%).Postoperative adjuvant chemotherapy was initiated on September 17,2020.Taxol plus cisplatin was administered for only one cycle because of severe liver function damage,and the regimen was changed to etoposide plus cisplatin on October 10,2020 for five cycles.The patient recovered,with no recurrence after 6 mo of follow-up.CONCLUSION Gastric MNECs(GMNECs)is a rare type of GRC.This study presented the unusual occurrence of GMNEC in the gastric stump.This case will contribute to improvements in our understanding of the carcinogenesis,biology,pathology,and behavior of GMNEC and GRC.

关键词： Gastric remnant cancer Gastric mixed neuroendocrine carcinoma Surgery Gastric stump billroth ii Case report

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Randomized controlled trial of uncut Roux-en-Y vs billroth Ⅱ reconstruction after distal gastrectomy for gastric cancer: Which technique is better for avoiding biliary reflux and gastritis?

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World Journal of Gastroenterology 2017年第34期23卷 6350-6356页

作者： Dong Yang Liang He Wei-Hua Tong Zhi-Fang Jia Tong-Rong Su Quan Wang Department of Gastrointestinal and Anal Surgery The First Hospital of Jilin University Division of Clinical Research The First Hospital of Jilin University

AIM To identify which technique is better for avoiding biliary reflux and gastritis between uncut Roux-en-Y and billroth Ⅱ reconstruction. METHODS A total of 158 patients who underwent laparoscopyassisted distal gastrectomy for gastric cancer at the First Hospital of Jilin University(Changchun, China) between February 2015 and February 2016 were randomized into two groups: uncut Roux-en-Y(group U) and billroth ii group(group B). Postoperative complications and relevant clinical data were compared between the two groups. RESULTS According to the randomization table, each group included 79 patients. There was no significant difference in postoperative complications between groups U and B(7.6% vs 10.1%, P = 0.576). During the postoperative period, group U stomach p H values were lower than 7 and group B p H values were higher than 7. After 1 year of follow-up, group B presented a higher incidence of biliary reflux and alkaline gastritis. However, histopathology did not show a significant difference in gastritis diagnosis(P = 0.278), and the amount of residual food and gain of weight between the groups were also not significantly different. At 3 mo there was no evidence of partial recanalization of uncut staple line, but at 1 year the incidence was 13%. CONCLUSION Compared with billroth ii reconstruction, uncut Rouxen-Y reconstruction is secure and feasible, and can effectively reduce the incidence of alkaline reflux, residual gastritis, and heartburn. Despite the incidence of recanalization, uncut Roux-en-Y should be widely applied.

关键词： Gastric cancer Uncut Roux-en-Y billroth ii Bile reflux Alkaline gastritis

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