Skip to main content
Erschienen in:

07.01.2022 | Gastrointestinal Oncology

A Modified Billroth-II with Braun Anastomosis in Totally Laparoscopic Distal Gastrectomy: Initial Experience Compared with Roux-en-Y Anastomosis

verfasst von: Abudushalamu Yalikun, MD, Batuer Aikemu, MD, Shuchun Li, MD, Tao Zhang, MD, PhD, Junjun Ma, MD, PhD, Minhua Zheng, MD, PhD, Lu Zang, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 4/2022

Einloggen, um Zugang zu erhalten

Abstract

Background

This retrospective study aimed to compare the feasibility and effectiveness of a modified Billroth-II with Braun (B-II Braun) reconstruction and those of a Roux-en-Y (R-Y) reconstruction after laparoscopic distal gastrectomy.

Methods

From January 2016 to December 2019, 247 patients underwent total laparoscopic distal gastrectomy (TLDG), with B-II Braun reconstruction for 145 patients and R-Y reconstruction for 102 patients. The patients’ data were collected prospectively and reviewed retrospectively.

Results

In this study, the median times of the operation were statistically shorter for B-II Braun than for R-Y (167 min [range, 110–331 min] vs 191 min [range, 123–384 min]; p = 0.001), including anastomotic times (33 min [range, 30–42 min] vs 42 min [range, 40–48 min]; p = 0.001). After a short-term follow-up period, endoscopy showed 31 cases of bile reflux (21.4%), 15 cases of grade 2 gastritis (10.3%), and 6 cases of grade 2 food residue (4.1%) in the B-II Braun group after 6 months. After 1 year, 10 patients (6.9%) had grade 2 gastritis and 2 patients (1.4%) had grade 3 gastritis. However, the remnant stomach of the two groups did not differ significantly in the rate of gastric residue (p = 0.112 after 6 months; p = 0.579 after 1 year, respectively), gastritis (p = 0.726 after 6 months; p = 0.261 after 1 year, respectively), or bile reflux (p = 0.262 after 6 months; p = 0.349 after 1 year, respectively).

Conclusions

For gastric cancer patients, TLDG with modified B-II Braun reconstruction could be technically feasible. It has an acceptable range of postoperative complications and is effective in preventing bile reflux into the gastric remnant.
Literatur
1.
Zurück zum Zitat Cao M, et al. Cancer burden of major cancers in China: a need for sustainable actions. Cancer Commun Lond Engl. 2020;40:205–10.CrossRef Cao M, et al. Cancer burden of major cancers in China: a need for sustainable actions. Cancer Commun Lond Engl. 2020;40:205–10.CrossRef
2.
Zurück zum Zitat Jeong O, Park YK. Clinicopathological features and surgical treatment of gastric cancer in South Korea: the results of 2009 nationwide survey on surgically treated gastric cancer patients. J Gastric Cancer. 2011;11:69–77.PubMedPubMedCentralCrossRef Jeong O, Park YK. Clinicopathological features and surgical treatment of gastric cancer in South Korea: the results of 2009 nationwide survey on surgically treated gastric cancer patients. J Gastric Cancer. 2011;11:69–77.PubMedPubMedCentralCrossRef
3.
Zurück zum Zitat Paimela H, et al. Long-term results after surgery for gastric cancer with or without jejunal reservoir: results of surgery for gastric cancer in Kanta-Hame central hospital in two consecutive periods without or with jejunal pouch reconstruction in 1985–1998. Int J Gastrointest Cancer. 2005;36(3):147–53.PubMedCrossRef Paimela H, et al. Long-term results after surgery for gastric cancer with or without jejunal reservoir: results of surgery for gastric cancer in Kanta-Hame central hospital in two consecutive periods without or with jejunal pouch reconstruction in 1985–1998. Int J Gastrointest Cancer. 2005;36(3):147–53.PubMedCrossRef
4.
Zurück zum Zitat Svensson JO. Duodenogastric reflux after gastric surgery. Scand J Gastroenterol. 1983;18:729–34.PubMedCrossRef Svensson JO. Duodenogastric reflux after gastric surgery. Scand J Gastroenterol. 1983;18:729–34.PubMedCrossRef
5.
Zurück zum Zitat Yu J, et al. Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer: the CLASS-01 randomized clinical trial. JAMA. 2019;321:1983–92.PubMedPubMedCentralCrossRef Yu J, et al. Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer: the CLASS-01 randomized clinical trial. JAMA. 2019;321:1983–92.PubMedPubMedCentralCrossRef
6.
Zurück zum Zitat Inaki N, et al. A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg. 2015;39:2734–41.PubMedCrossRef Inaki N, et al. A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg. 2015;39:2734–41.PubMedCrossRef
7.
Zurück zum Zitat Lee HJ, et al. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 Lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg. 2019;270:983–91.PubMedCrossRef Lee HJ, et al. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 Lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg. 2019;270:983–91.PubMedCrossRef
8.
Zurück zum Zitat In Choi C, et al. Comparison between Billroth-II with Braun and Roux-en-Y reconstruction after laparoscopic distal gastrectomy. J Gastrointest Surg. 2016;20:1083–90.PubMedCrossRef In Choi C, et al. Comparison between Billroth-II with Braun and Roux-en-Y reconstruction after laparoscopic distal gastrectomy. J Gastrointest Surg. 2016;20:1083–90.PubMedCrossRef
9.
Zurück zum Zitat Son T, et al. Multi-institutional validation of the 8th AJCC TNM staging system for gastric cancer: analysis of survival data from high-volume Eastern centers and the SEER database. J Surg Oncol. 2019;120:676–84.PubMed Son T, et al. Multi-institutional validation of the 8th AJCC TNM staging system for gastric cancer: analysis of survival data from high-volume Eastern centers and the SEER database. J Surg Oncol. 2019;120:676–84.PubMed
10.
Zurück zum Zitat Kubo M, et al. Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer. 2002;5:83–9.PubMedCrossRef Kubo M, et al. Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer. 2002;5:83–9.PubMedCrossRef
11.
Zurück zum Zitat Nomura E, et al. Functional outcomes according to the size of the gastric remnant and the type of reconstruction following distal gastrectomy for gastric cancer: an investigation including total gastrectomy. Jpn J Clin Oncol. 2013;43:1195–202.PubMedCrossRef Nomura E, et al. Functional outcomes according to the size of the gastric remnant and the type of reconstruction following distal gastrectomy for gastric cancer: an investigation including total gastrectomy. Jpn J Clin Oncol. 2013;43:1195–202.PubMedCrossRef
12.
Zurück zum Zitat Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021;24:1–21. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021;24:1–21.
13.
Zurück zum Zitat Kim W, et al. Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg. 2016;263:28–35.PubMedCrossRef Kim W, et al. Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg. 2016;263:28–35.PubMedCrossRef
14.
Zurück zum Zitat Katai H, et al. Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer. 2017;20:699–708.PubMedCrossRef Katai H, et al. Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer. 2017;20:699–708.PubMedCrossRef
15.
Zurück zum Zitat van Heerden JA, et al. Postoperative alkaline reflux gastritis: surgical implications. Am J Surg. 1969;118:427–33.PubMedCrossRef van Heerden JA, et al. Postoperative alkaline reflux gastritis: surgical implications. Am J Surg. 1969;118:427–33.PubMedCrossRef
16.
Zurück zum Zitat Zobolas B, et al. Alkaline reflux gastritis: early and late results of surgery. World J Surg. 2006;30:1043–9.PubMedCrossRef Zobolas B, et al. Alkaline reflux gastritis: early and late results of surgery. World J Surg. 2006;30:1043–9.PubMedCrossRef
17.
Zurück zum Zitat Kumagai K, et al. Questionnaire survey regarding the current status and controversial issues concerning reconstruction after gastrectomy in Japan. Surg Today. 2012;42:411–8.PubMedCrossRef Kumagai K, et al. Questionnaire survey regarding the current status and controversial issues concerning reconstruction after gastrectomy in Japan. Surg Today. 2012;42:411–8.PubMedCrossRef
18.
Zurück zum Zitat Hoya Y, Mitsumori N, Yanaga K. The advantages and disadvantages of a Roux-en-Y reconstruction after a distal gastrectomy for gastric cancer. Surg Today. 2009;39:647–51.PubMedCrossRef Hoya Y, Mitsumori N, Yanaga K. The advantages and disadvantages of a Roux-en-Y reconstruction after a distal gastrectomy for gastric cancer. Surg Today. 2009;39:647–51.PubMedCrossRef
19.
Zurück zum Zitat Bartlett MK, Burrington JD. Bilious vomiting after gastric surgery: experience with a modified Roux-Y loop for relief. Arch Surg. 1968;97:34–9.PubMedCrossRef Bartlett MK, Burrington JD. Bilious vomiting after gastric surgery: experience with a modified Roux-Y loop for relief. Arch Surg. 1968;97:34–9.PubMedCrossRef
20.
21.
Zurück zum Zitat Bushkin FL, Woodward ER. Alkaline reflux gastritis. Major Probl Clin Surg. 1976;20:48–63.PubMed Bushkin FL, Woodward ER. Alkaline reflux gastritis. Major Probl Clin Surg. 1976;20:48–63.PubMed
22.
Zurück zum Zitat Kennedy T, Green R. Roux diversion for bile reflux following gastric surgery. Br J Surg. 1978;65:323–5.PubMedCrossRef Kennedy T, Green R. Roux diversion for bile reflux following gastric surgery. Br J Surg. 1978;65:323–5.PubMedCrossRef
23.
Zurück zum Zitat Herrington JJ. Editorial: Roux-en-Y diversion as an alternate method of reconstruction of the alimentary tract after primary resection of the stomach. Surg Gynecol Obstet. 1976;143:92–3.PubMed Herrington JJ. Editorial: Roux-en-Y diversion as an alternate method of reconstruction of the alimentary tract after primary resection of the stomach. Surg Gynecol Obstet. 1976;143:92–3.PubMed
24.
Zurück zum Zitat Shah K, et al. Long-term effects of laparoscopic Roux-en-Y gastric bypass on metabolic syndrome in patients with morbid obesity. Surg Obes Relat Dis. 2016;12:1449–56.PubMedCrossRef Shah K, et al. Long-term effects of laparoscopic Roux-en-Y gastric bypass on metabolic syndrome in patients with morbid obesity. Surg Obes Relat Dis. 2016;12:1449–56.PubMedCrossRef
25.
Zurück zum Zitat Masui T, et al. The flow angle beneath the gastrojejunostomy predicts delayed gastric emptying in Roux-en-Y reconstruction after distal gastrectomy. Gastric Cancer. 2012;15:281–6.PubMedCrossRef Masui T, et al. The flow angle beneath the gastrojejunostomy predicts delayed gastric emptying in Roux-en-Y reconstruction after distal gastrectomy. Gastric Cancer. 2012;15:281–6.PubMedCrossRef
26.
Zurück zum Zitat Van Stiegmann G, Goff JS. An alternative to Roux-en-Y for treatment of bile reflux gastritis. Surg Gynecol Obstet. 1988;166:69–70.PubMed Van Stiegmann G, Goff JS. An alternative to Roux-en-Y for treatment of bile reflux gastritis. Surg Gynecol Obstet. 1988;166:69–70.PubMed
27.
Zurück zum Zitat Lee M, et al. What is the best reconstruction method after distal gastrectomy for gastric cancer? Surg Endosc. 2012;26:1539–47.PubMedCrossRef Lee M, et al. What is the best reconstruction method after distal gastrectomy for gastric cancer? Surg Endosc. 2012;26:1539–47.PubMedCrossRef
28.
Zurück zum Zitat Tran TB, et al. To Roux or not to Roux: a comparison between Roux-en-Y and Billroth II reconstruction following partial gastrectomy for gastric cancer. Gastric Cancer. 2016;19:994–1001.PubMedCrossRef Tran TB, et al. To Roux or not to Roux: a comparison between Roux-en-Y and Billroth II reconstruction following partial gastrectomy for gastric cancer. Gastric Cancer. 2016;19:994–1001.PubMedCrossRef
29.
Zurück zum Zitat Cui L, et al. Billroth II with Braun enteroenterostomy is a good alternative reconstruction to Roux-en-Y gastrojejunostomy in laparoscopic distal gastrectomy. Gastroenterol Res Pract. 2017;2017:1803851–6.PubMedPubMedCentralCrossRef Cui L, et al. Billroth II with Braun enteroenterostomy is a good alternative reconstruction to Roux-en-Y gastrojejunostomy in laparoscopic distal gastrectomy. Gastroenterol Res Pract. 2017;2017:1803851–6.PubMedPubMedCentralCrossRef
30.
Zurück zum Zitat Pan Y, et al. Beneficial effects of jejunal continuity and duodenal food passage after total gastrectomy: a retrospective study of 704 patients. Eur J Surg Oncol. 2008;34:17–22.PubMedCrossRef Pan Y, et al. Beneficial effects of jejunal continuity and duodenal food passage after total gastrectomy: a retrospective study of 704 patients. Eur J Surg Oncol. 2008;34:17–22.PubMedCrossRef
31.
Zurück zum Zitat Goh P, et al. Totally intra-abdominal laparoscopic Billroth II gastrectomy. Surg Endosc. 1992;6:160.PubMedCrossRef Goh P, et al. Totally intra-abdominal laparoscopic Billroth II gastrectomy. Surg Endosc. 1992;6:160.PubMedCrossRef
32.
Zurück zum Zitat Kim JH, Jun KH, Chin HM. Short-term surgical outcomes of laparoscopy-assisted versus totally laparoscopic Billroth-II gastrectomy for gastric cancer: a matched-cohort study. BMC Surg. 2017;17:45.PubMedPubMedCentralCrossRef Kim JH, Jun KH, Chin HM. Short-term surgical outcomes of laparoscopy-assisted versus totally laparoscopic Billroth-II gastrectomy for gastric cancer: a matched-cohort study. BMC Surg. 2017;17:45.PubMedPubMedCentralCrossRef
33.
Zurück zum Zitat Shim JH, et al. Roux-en-Y gastrojejunostomy after totally laparoscopic distal gastrectomy: comparison with Billorth II reconstruction. Surg Laparosc Endosc Percutan Tech. 2014;24:448–51.PubMedCrossRef Shim JH, et al. Roux-en-Y gastrojejunostomy after totally laparoscopic distal gastrectomy: comparison with Billorth II reconstruction. Surg Laparosc Endosc Percutan Tech. 2014;24:448–51.PubMedCrossRef
34.
Zurück zum Zitat Lee J, Kim D, Kim W. Comparison of laparoscopy-assisted and totally laparoscopic Billroth-II distal gastrectomy for gastric cancer. J Korean Surg Soc. 2012;82:135–42.PubMedPubMedCentralCrossRef Lee J, Kim D, Kim W. Comparison of laparoscopy-assisted and totally laparoscopic Billroth-II distal gastrectomy for gastric cancer. J Korean Surg Soc. 2012;82:135–42.PubMedPubMedCentralCrossRef
35.
Zurück zum Zitat Yoshikawa K, et al. Characteristics of internal hernia after gastrectomy with Roux-en-Y reconstruction for gastric cancer. Surg Endosc. 2014;28:1774–8.PubMedCrossRef Yoshikawa K, et al. Characteristics of internal hernia after gastrectomy with Roux-en-Y reconstruction for gastric cancer. Surg Endosc. 2014;28:1774–8.PubMedCrossRef
36.
Zurück zum Zitat Shoji Y, et al. Features of the complications for intracorporeal Billroth-I and Roux-en-Y reconstruction after laparoscopic distal gastrectomy for gastric cancer. Langenbecks Arch Surg. 2021;406:1425–32.PubMedCrossRef Shoji Y, et al. Features of the complications for intracorporeal Billroth-I and Roux-en-Y reconstruction after laparoscopic distal gastrectomy for gastric cancer. Langenbecks Arch Surg. 2021;406:1425–32.PubMedCrossRef
37.
Zurück zum Zitat Griffiths JMT, et al. The results of reoperation for bile vomiting following surgery for peptic ulcer. Br J Surg. 1974;61:838–43.PubMedCrossRef Griffiths JMT, et al. The results of reoperation for bile vomiting following surgery for peptic ulcer. Br J Surg. 1974;61:838–43.PubMedCrossRef
38.
Zurück zum Zitat Vogel SB, Drane WE, Woodward ER. Clinical and radionuclide evaluation of bile diversion by Braun enteroenterostomy: prevention and treatment of alkaline reflux gastritis: an alternative to Roux-en-Y diversion. Ann Surg. 1994;219:458–65 (discussion 465–6).PubMedPubMedCentralCrossRef Vogel SB, Drane WE, Woodward ER. Clinical and radionuclide evaluation of bile diversion by Braun enteroenterostomy: prevention and treatment of alkaline reflux gastritis: an alternative to Roux-en-Y diversion. Ann Surg. 1994;219:458–65 (discussion 465–6).PubMedPubMedCentralCrossRef
39.
Zurück zum Zitat Smolskas E, Lunevicius R, Samalavicius NE. Quality of life after subtotal gastrectomy for gastric cancer: does restoration method matter? A retrospective cohort study. Ann Med Surg Lond. 2015;4:371–5.PubMedPubMedCentralCrossRef Smolskas E, Lunevicius R, Samalavicius NE. Quality of life after subtotal gastrectomy for gastric cancer: does restoration method matter? A retrospective cohort study. Ann Med Surg Lond. 2015;4:371–5.PubMedPubMedCentralCrossRef
40.
Zurück zum Zitat Chan DC, et al. Roux-en-Y reconstruction after distal gastrectomy to reduce enterogastric reflux and Helicobacter pylori infection. J Gastrointest Surg. 2007;11:1732–40.PubMedCrossRef Chan DC, et al. Roux-en-Y reconstruction after distal gastrectomy to reduce enterogastric reflux and Helicobacter pylori infection. J Gastrointest Surg. 2007;11:1732–40.PubMedCrossRef
41.
42.
Zurück zum Zitat Park JY, Kim YJ. Uncut Roux-en-Y reconstruction after laparoscopic distal gastrectomy can be a favorable method in terms of gastritis, bile reflux, and gastric residue. J Gastric Cancer. 2014;14:229–37.PubMedPubMedCentralCrossRef Park JY, Kim YJ. Uncut Roux-en-Y reconstruction after laparoscopic distal gastrectomy can be a favorable method in terms of gastritis, bile reflux, and gastric residue. J Gastric Cancer. 2014;14:229–37.PubMedPubMedCentralCrossRef
Metadaten
Titel
A Modified Billroth-II with Braun Anastomosis in Totally Laparoscopic Distal Gastrectomy: Initial Experience Compared with Roux-en-Y Anastomosis
verfasst von
Abudushalamu Yalikun, MD
Batuer Aikemu, MD
Shuchun Li, MD
Tao Zhang, MD, PhD
Junjun Ma, MD, PhD
Minhua Zheng, MD, PhD
Lu Zang, MD, PhD
Publikationsdatum
07.01.2022
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 4/2022
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-021-11187-4

Neu im Fachgebiet Chirurgie

Appendizitis und Darminfarkt durch Blinddarm-Lipom

Eigentlich sind Lipome recht harmlos. Im Zäkum können sie jedoch erhebliche Komplikationen mit Darminfarkt und Appendizitis verursachen.

Gluteuslappen nach Rektumkarzinom-Op. schützt vor Abszessen

Die Wunddeckung mit einem autologen Rotationslappen nach Entfernung eines Rektumkarzinoms konnte in einer randomisierten Studie gegenüber dem primären Wundverschluss vor allem in einer Hinsicht punkten: Sie führte deutlich seltener zu präsakralen Abszessen.

Antibiotika bei Erwachsenen mit Appendizitis oft ausreichend

Bei etwa zwei Drittel aller Erwachsenen mit akuter Appendizitis könnte eine antibiotische Behandlung ausreichen, wie eine Metaanalyse nahelegt. Die Komplikationsrate war insgesamt gering, auch wenn letztlich doch eine Op. fällig wurde.

Katheterablation bei Vorhofflimmern: Ist frühe Intervention von Vorteil?

Bei Patienten mit Vorhofflimmern scheinen die Therapieergebnisse bezüglich Rezidivfreiheit bei frühzeitiger Katheterablation besser zu sein als bei später erfolgter Ablation. Dafür sprechen Ergebnisse einer aktuellen Registeranalyse. 

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.