The advantages and disadvantages of a Roux-en-Y reconstruction after a distal gastrectomy for gastric cancer |
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Authors: | Yoshiyuki Hoya Norio Mitsumori Katsuhiko Yanaga |
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Institution: | (1) Department of Surgery, Daisan Hospital, The Jikei University School of Medicine, 4-11-1 Izumihon-cho, Komae, Tokyo 201-8601, Japan;(2) Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan |
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Abstract: | In Japan, the Billroth I and Billroth II operations have been used for reconstruction after a distal gastrectomy for gastric
cancer. However, a Roux-en-Y reconstruction is increasingly performed to prevent duodenogastric reflux. We herein discuss
the indications for Roux-en-Y in gastric surgery and review the literature to determine its advantages and disadvantages.
Indications for Roux-en-Y reconstruction after a distal gastrectomy are: (a) When the primary lesion has directly invaded
the duodenum or head of the pancreas, the Billroth I operation is likely to result in local recurrence near the anastomosis;
(b) in addition, the Billroth I operation is not indicated after a subtotal gastrectomy due to an unacceptable anastomotic
tension; reconstruction using a nonphysiological route is therefore preferred. The advantages of Roux-en-Y reconstruction
after a distal gastrectomy include a reduction of reflux gastritis and esophagitis, a decreased probability of gastric cancer
recurrence, and a reduction in the incidence of surgical complications such as ruptured suture lines. The disadvantages of
Roux-en-Y reconstruction include the possible development of stomal ulcer, an increased probability of cholelithiasis, increased
difficulty with an endoscopic approach to the ampulla of Vater, and the possibility of Roux stasis syndrome. The principal
advantage of a Roux-en-Y reconstruction is that it is less likely than the Billroth I operation to result in duodenogastric
reflux. Roux-en-Y reconstruction or Billroth I operation can only be selected after considering their respective advantages
and disadvantages. |
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Keywords: | Pyloric cancer Stapling anastomosis Roux-en-Y reconstruction Stomal ulcer Gastritis of the residual stomach |
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