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01-12-2011 | Original Article

Different Features of Complications with Billroth-I and Roux-en-Y Reconstruction After Laparoscopy-Assisted Distal Gastrectomy

Authors: Koshi Kumagai, Naoki Hiki, Souya Nunobe, Xiaohua Jiang, Takeshi Kubota, Susumu Aikou, Ryohei Watanabe, Shinya Tanimura, Takeshi Sano, Yuko Kitagawa, Toshiharu Yamaguchi

Published in: Journal of Gastrointestinal Surgery | Issue 12/2011

Abstract

Background

This study investigated differences in the features of postoperative complications between Billroth-I (B-I) and Roux-en-Y (R-Y) reconstructions after laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer.

Material and methods

The study included 424 patients who underwent LADG for cT1, cN0 gastric cancer. Patient characteristics, surgical outcomes, postoperative complications including severity assessment using the Clavien–Dindo classification, and risk factors related to postoperative complications were analyzed.

Results

B-I and R-Y were performed in 329 and 95 patients, respectively. Total time in hospital was longer in R-Y (15.2 ± 10.5 days) than in B-I (12.8 ± 6.4 days; P = 0.034). The incidence of severe complications was higher in R-Y (13.7%) than in B-I (5.2%; P = 0.009). Three cases of internal hernia and three cases of duodenal stump leakage were observed in R-Y. Univariate analysis revealed the method of reconstruction was a risk factor for severe postoperative complications after LADG (P = 0.006).

Conclusions

The features of postoperative complications are quite different between B-I and R-Y after LADG. Complications after R-Y were more severe than those after B-I. To avoid these severe complications in R-Y, it is necessary to understand these different features.

Lundegardh G, Adami HO, Helmick C et al. Stomach cancer after partial gastrectomy for benign ulcer disease. N Engl J Med 1988; 319:195–200.PubMedCrossRef

Katai H, Nunobe S, Saka M et al. [Reconstruction after distal gastrectomy]. Nippon Geka Gakkai Zasshi 2008; 109:264–268.PubMed

Kobori O, Shimizu T, Maeda M et al. Enhancing effect of bile and bile acid on stomach tumorigenesis induced by N-methyl-N′-nitro-N-nitrosoguanidine in Wistar rats. J Natl Cancer Inst 1984; 73:853–861.PubMed

Ishikawa M, Kitayama J, Kaizaki S et al. Prospective randomized trial comparing Billroth I and Roux-en-Y procedures after distal gastrectomy for gastric carcinoma. World J Surg 2005; 29:1415–1420.PubMedCrossRef

Nunobe S, Okaro A, Sasako M et al. Billroth 1 versus Roux-en-Y reconstructions: a quality-of-life survey at 5 years. Int J Clin Oncol 2007; 12:433–439.PubMedCrossRef

Kim MC, Kim W, Kim HH et al. Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale Korean Multicenter Study. Ann Surg Oncol 2008; 15:2692–2700.PubMedCrossRef

Kitano S, Shiraishi N, Uyama I et al. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 2007; 245:68–72.PubMedCrossRef

Hiki N, Fukunaga T, Tokunaga M et al. An effective duodenum bulb mobilization for extracorporeal Billroth I anastomosis of laparoscopic gastrectomy. J Gastrointest Surg 2009; 13:230–235.PubMedCrossRef

Katai H, Sasako M, Fukuda H et al. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 2010; 13:238–244.PubMedCrossRef

10.

Kojima K, Yamada H, Inokuchi M et al. A comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg 2008; 247:962–967.PubMedCrossRef

11.

Clavien PA, Barkun J, de Oliveira ML et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250:187–196.PubMedCrossRef

12.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240:205–213.PubMedCrossRef

13.

Hiki N, Fukunaga T, Yamaguchi T et al. Cut-and-screw insertion: a method for safe and speedy secondary trocar insertion in laparoscopic surgery. Surg Technol Int 2008; 17:121–125.PubMed

14.

Kalff JC, Schraut WH, Simmons RL et al. Surgical manipulation of the gut elicits an intestinal muscularis inflammatory response resulting in postsurgical ileus. Ann Surg 1998; 228:652–663.PubMedCrossRef

15.

Kalff JC, Carlos TM, Schraut WH et al. Surgically induced leukocytic infiltrates within the rat intestinal muscularis mediate postoperative ileus. Gastroenterology 1999; 117:378–387.PubMedCrossRef

16.

Schwarz NT, Beer-Stolz D, Simmons RL et al. Pathogenesis of paralytic ileus: intestinal manipulation opens a transient pathway between the intestinal lumen and the leukocytic infiltrate of the jejunal muscularis. Ann Surg 2002; 235:31–40.PubMedCrossRef

17.

Ryu KW, Kim YW, Lee JH et al. Surgical complications and the risk factors of laparoscopy-assisted distal gastrectomy in early gastric cancer. Ann Surg Oncol 2008; 15:1625–1631.PubMedCrossRef

18.

Kim W, Song KY, Lee HJ et al. The impact of comorbidity on surgical outcomes in laparoscopy-assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg 2008; 248:793–799.PubMedCrossRef

19.

Coleman MH, Awad ZT, Pomp A et al. Laparoscopic closure of the Petersen mesenteric defect. Obes Surg 2006; 16:770–772.PubMedCrossRef

20.

Koppman JS, Li C, Gandsas A. Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass: a review of 9,527 patients. J Am Coll Surg 2008; 206:571–584.PubMedCrossRef

21.

Carmody B, DeMaria EJ, Jamal M et al. Internal hernia after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2005; 1:543–548.PubMedCrossRef

22.

Felsher J, Brodsky J, Brody F. Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Surgery 2003; 134:501–505.PubMedCrossRef

23.

Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg 2003; 13:350–354.PubMedCrossRef

24.

Iannelli A, Facchiano E, Gugenheim J. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg 2006; 16:1265–1271.PubMedCrossRef

25.

Nguyen NT, Huerta S, Gelfand D et al. Bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2004; 14:190–196.PubMedCrossRef

26.

Podnos YD, Jimenez JC, Wilson SE et al. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg 2003; 138:957–961.PubMedCrossRef

27.

Schauer PR, Ikramuddin S, Gourash W et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000; 232:515–529.PubMedCrossRef

Title: Different Features of Complications with Billroth-I and Roux-en-Y Reconstruction After Laparoscopy-Assisted Distal Gastrectomy
Authors: Koshi Kumagai
Naoki Hiki
Souya Nunobe
Xiaohua Jiang
Takeshi Kubota
Susumu Aikou
Ryohei Watanabe
Shinya Tanimura
Takeshi Sano
Yuko Kitagawa
Toshiharu Yamaguchi
Publication date: 01-12-2011
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 12/2011
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-011-1683-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Different Features of Complications with Billroth-I and Roux-en-Y Reconstruction After Laparoscopy-Assisted Distal Gastrectomy

Abstract

Background

Material and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Material and methods

Results

Conclusions

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