Published in:
01-09-2003 | Original Article
Evaluation of gastroesophageal reflux disease following various reconstructive procedures for a distal gastrectomy
Published in: Langenbeck's Archives of Surgery | Issue 4/2003
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Background and aims
Some patients develop gastroesophageal reflux disease (GERD) after a distal gastrectomy. In these patients, the evaluation of GERD with 24-h pH monitoring could be difficult because they may have an insufficient amount of gastric acid.
Patients and methods
To evaluate GERD following a distal gastrectomy, we retrospectively evaluated 38 patients postoperatively with an acid reflux test (ART), a barium study, endoscopy, and esophageal manometry. Three reconstructive procedures, Billroth I (B-I group: 14 patients), Billroth II (B-II group: 11 patients), and jejunal interposition (interposition group: 13 patients) were compared with respect to GERD and short- term operation results.
Results
Operation time and postoperative hospital stay were longest in the interposition group. Reflux symptoms were present in ten patients (26%). The ART, barium study and endoscopy demonstrated evidence of GERD in 22 (58%), 10 (26%) and 4 (11%) of the 38 patients, respectively. The frequency of a positive ART in the interposition group was significantly lower than in both the B-I and the B-II groups. The abdominal length of the lower esophageal sphincter in the interposition group was higher than that in the B-II group (P<0.05).
Conclusion
Although jejunal interposition required longer operation time and hospital stay, the lower esophageal sphincter function following jejunal interposition appears to be superior to that following a Billroth-I or Billroth-II procedure.