A comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gastrectomy

Objective: The present study evaluated the efficacy of Roux-en-Y (R-Y) reconstruction and Billroth-I (B-I) reconstruction after laparoscopy-assisted distal gastrectomy (LADG). Patients and Methods: Between October 2000 and February 2006, a total of 133 consecutive patients who underwent LADG for gastric carcinoma were classified into 2 groups according to reconstruction (B-I, n = 65; R-Y, n = 68). Parameters analyzed included patients and tumor characteristics, operative details, postoperative outcomes, and nourishment state. Endoscopic findings of the gastric remnant and lower esophagus were evaluated at 12 months postoperatively. Results: Regarding postoperative complications, no significant differences were found between groups. In the B-I group, 3 patients developed anastomotic leakage and 4 patients suffered anastomotic stricture requiring endoscopic balloon dilation. So-called functional stasis after R-Y reconstruction was not found in this study. Incidence of heartburn at 12 months postoperatively was 37% in the B-I group and 8% in the R-Y group (P = 0.0002). Amount of meal consumed compared with preoperative value at 12 months postoperatively was significantly higher for the R-Y group than for the B-I group (83.6% 15.3% vs. 77.8% +/- 16.0%; P = 0.047). Endoscopic findings showed that incidence of remnant gastritis was significantly lower in the R-Y group than in the B-I group (12% vs. 34%; P = 0.002). Bile reflux into the remnant stomach was not observed in the R-Y group. Conclusion: R-Y reconstruction seems superior to B-I reconstruction for preventing both bile reflux into the gastric remnant and postoperative complications. We consider R-Y reconstruction as a feasible and safe method for LADG.