Comparison of Billroth-I and Roux-en Y Reconstruction in Early Outcomes Following Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

Shuhei Komatsu, MD, Daisuke Ichikawa, MD, Kazuma Okamoto, MD, Atsushi Shiozaki, MD, Hitoshi Fujiwara, MD, Yasutoshi Murayama, MD, Yoshiaki Kuriu, MD, Hisashi Ikoma, MD, Masayoshi Nakanishi, MD, Toshiya Ochiai, MD, Yukihito Kokuba, MD, Eigo Otsuji. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine


BACKGROUND: Clinical course and complication rate following laparoscopy-assisted distal gastrectomy (LADG) are influenced by clinical technical expertise and experience because reconstruction is performed through a small mini laparotomy window. This study was designed to compare postoperative complications of Billroth-I and Roux-en Y reconstructions following LADG for gastric cancer.
PATIENTS AND METHODS: Between October 1997 and April 2009, 80 consecutive patients underwent LADG. These patients were classified into two groups: Billroth-I group (n = 49) and Roux-en Y group (n = 31), and the patient and tumor characteristics, surgical details, and postoperative complications were analyzed.
RESULTS: 1) Billroth-I reconstruction was performed more frequently in the lower portion of the stomach (p < 0.05) and yielded shorter surgical durations ( p < 0.05 ) and reduced blood loss ( p < 0.01 ), although there were no significant differences in patient age, gender, BMI, pN-stage, pT-stage or extent of lymphadenectomy. 2) The overall postoperative complication rates did not significantly differ ( p = 0.25 ). However, the rate of stasis was 19.4 % in Roux-en Y group, which was higher than that in Billroth-I group (2.0 %) ( p < 0.05 ). 3) Concerning the clinical factors associated with a long hospital stay, Roux-en Y group showed a tendency toward a longer hospital stay ( p=0.058 ). Postoperative complications ( p < 0.0001 ) and stasis ( p < 0.0001) were significantly associated with a longer postoperative hospital stay.
CONCLUSIONS: Billroth-I technique is a feasible and safe reconstruction method and not inferior to Roux-en Y reconstruction following LADG for gastric cancer.

Session Number: Poster – Poster Presentations
Program Number: P620
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