Cholelithiasis after Billroth II gastric resection

We evaluate whether Billroth II (BII) gastric resection is a predisposing condition in the formation of gallstones. In our department radiologic and echographic imaging is a routine examination before abdominal surgery. From 1980 to 1985, 202 patients underwent cholecystography or ultrasonography before BII gastric resections for peptic ulcers. The prevalence of cholelithiasis in a random sample of the population of the town near our institution was used to calculate the expected frequency of gallstones. The comparison of the expected and the observed frequencies of cholelithiasis in these patients did not show any statistically significant difference between men and women. All these patients were recalled for a follow-up of the long-term effects of gastric surgery, and 66% (133/202) returned and were examined. They underwent ultrasonography of the biliary tract. Again the observed and the expected (obtained as before) frequencies of cholelithiasis were compared. A statistically significant difference was apparent in male patients. We conclude that BII gastric resection could be a predisposing factor in the formation of gallstones in men.     

Risk of gastric cancer after Billroth II resection for duodenal ulcer

In a follow-up study of 1000 patients, who were subjected to Billroth II resection for duodenal ulcer, the incidence and mortality of gastric carcinoma in a 22-30 year follow-up period were determined. Among the 423 survivors traced, 196 underwent gastroscopy and biopsy but carcinomas of the gastric remnant were not seen. Thus the prevalence was 0, not significantly different from the expected prevalence of 0.3. From all 1000 patients only 13 cases of gastric carcinoma were identified. This is not significantly different from the expected number of 10.6 calculated by the life table method and indirectly standardized for age, sex, place of residence and time. Even more than 15 years after operation the gastric cancer risk was only slightly increased (observed/expected = 7/4.8 +/- 1.48), but this was not significant statistically. Of 522 deaths 13 were due to gastric carcinoma, which was not significantly different from the expected number of 10.2. These epidemiological data show that individuals subjected to Billroth II resection for duodenal ulcer hardly have a higher risk of gastric carcinoma than the general population within the first decades after operation. Thus proplylactic endoscopical monitoring will be unrewarding.     

Intussusception into the enteroanastomosis of Billroth II gastric resection.

A case of intussusception into the enteroanastomosis associated with a Billroth II gastric resection is presented. The case is discussed in the light of jejunogastric intussusceptions, described for the first time in 1917, about 30 years after the first gastrojejunostomy. For 30 years enteroanastomosis has been a general procedure in connection with the Billroth II type of gastric resection. The aetiology is discussed.     

Immediate results of gastric resection by Billroth I and Billroth II in peptic ulcer

An analysis of treatment of 1304 patients has shown the best immediate results to be after resection and re-resection of the stomach after Billroth-I as compared with Billroth-II: they had less amount of postoperative complications and lower lethality and maintained the passage of food through the duodenum.     

Follow-up of patients with Roux-technique gastric resection. Comparison of Billroth I and Billroth II gastric resections

The paper reports the results of a follow-up of 25 patients who underwent gastric resection using Roux's technique, 15 patients undergoing reconstructive surgery according to Pean-Billroth and 15 who underwent Billroth II operations. Controls were performed more than 5 years after surgery and included endoscopic tests with biopsy and the evaluation of the biliary salt reflux in the gastric stump. Roux's operation was preferred both as a routine operation following gastric resection and as a reconversion operation due to the absence of biliary reflux, the negative biopsy tests at the level of the stump and anastomosis, and negative clinical aspects.     

Late occurrence of precancerous changes and carcinoma of the gastric stump after Billroth II resection.

In a prospective study, patients resected for benign ulcer disease 20 years previously were followed up. Of 100 patients operated with anterior gastro-jejunal anastomosis and entero-anastomosis 51 were examined with gastroscopy and multiple biopsies taken from the stoma and gastric fundus. Acute and chronic inflammation of varying degrees were general findings. Single or multiple polyp-like changes at the stomal ring were found in 4 cases and in one patient an asymptomatic low differentiated, adenocarcinoma was found. Intestinal metaplasia and cystic dilatation of the gastric glands were most frequently found in the stomal biopsies and less frequent in biopsies taken from the gastric fundus. In order to evaluate these possibly precancerous changes all patients will be continuously controlled. Nineteen patients were dead at the time of the follow-up. One of these had died of carcinoma of the gastric remnant.     

Gastric emptying and postprandial symptoms after Billroth II resection

Gastric emptying was studied in 18 symptomatic and 16 asymptomatic patients after Billroth II (BII) resection (without vagotomy) and the possible relationships between emptying and postprandial symptoms in these patients were assessed. The BII patients were compared with 20 nonoperated patients who had duodenal ulcer disease and 16 healthy subjects. Gastric emptying of two test meals (a semisolid porridge meal and a solid pancake meal) was measured with a radionuclide technique. The major difference between the BII patients and control subjects and duodenal ulcer patients was an increased rate of emptying of the semisolid meal in the first 5 minutes after meal consumption. The percentage of the meal remaining in the stomach at 5 minutes after completion was significantly less in the symptomatic (45.3% +/- 4.3%) than in the asymptomatic BII patients (79.4% +/- 2.6%). A positive correlation was demonstrated between the initial emptying rate of semisolids and the intensity of postprandial nausea (p less than 0.01), vomiting (p less than 0.05), and vasomotor symptoms (p less than 0.001). The duration of the lag phase for solid and semisolid meals was shorter in BII patients than in healthy subjects but was as short in nonoperated duodenal ulcer patients. The duration of the lag phase for solid food in the BII patients correlated positively with the score for postprandial epigastric pain (p less than 0.001). The rate of emptying of the solid meal was lower in symptomatic BII patients (28.1% +/- 3.6% per hour) than in asymptomatic patients (47.8% +/- 7.2% per hour) and correlated with the severity of postprandial fullness and nausea. The emptying of the solid meal was inversely related to the initial emptying rate of the semisolid meal (p less than 0.05). Therefore, the results of this study support the assumption that many of the postprandial symptoms occurring after BII resection reflect alterations in gastric emptying. Some of the emptying abnormalities present after BII resection may be related to duodenal ulcer disease rather than to the surgical procedure.     

Results of Billroth I and Billroth II stomach resection

Between 1966 and 1986, Billroth I and Billroth II resections for gastroduodenal ulcers were performed at the Department of Surgery, Friedrich Schiller University, Jena. Early postoperative complications after Billroth II (14.6%) were somewhat rarer than after Billroth I (19.4%), however, bore a greater risk. With a permanent cure accounting for 85%, the comparison of both procedures reveals no significant differences in the late results. In gastric ulcer, Billroth's first method should be given preference because it can be carried out more rapidly in technical respect and takes digestive physiology into account.     

Endoscopic mucosal resection for early gastric carcinoma]

Endoscopic mucosal resection (EMR) has made it possible to perform radical resection of early gastric cancers in resectable cases. To extend the indications for EMR, we discuss the following. 1) Three hundred fifty-seven patients with 389 lesions of early gastric cancer who were treated either with whole-block resection or partial resection were analyzed to evaluate the recurrence rate by the method. The recurrence rate was 15.1% of 139 lesions treated with whole-block resection and 8.0% of 250 lesions treated with both methods. It is considered that partial resection with the marking procedure is very important to remove the cancer completely. 2) The management of recurrent cancer recognized at follow-up examination after EMR is very important for patients because these are operable cases. Of recurrent cancers, 80.5% were diagnosed within one year after EMR, and therefore during this period careful follow-up examinations should be done. The therapy used to treat these recurrent cancers was re-EMR in 26 cases and surgical operation in 15 cases. 3) Problems still remain concerning how to manage cancer invading the submucosa diagnosed after EMR.