The aim of this study was to evaluate the clinical characteristics, treatment, and prognosis of afferent loop syndrome (ALS) following radical subtotal gastrectomy with B-II reconstruction in gastric cancer patients. ALS is an infrequent mechanical complication, which occurs after reconstruction of Billroth-II (B-II) gastrojejunostomy or Roux-en-Y esophagojejunosotomy. From 2002 through 2010, 672 patients who had undergone subtotal gastrectomy with B-II reconstruction for gastric cancer were enrolled. Clinical data, symptom interval, cause, and treatment of 13 ALS patients were reviewed. The body mass index (BMI) of patients who suffered ALS was significantly less than that of patients who did not (P = 0.0244). And, there were significant differences in rates of recurrence (P = 0.0032) and follow-up duration (P = 0.0119) between the two groups. Acute ALS within 1 month occurred in 5 patients (38.5%). Obstructive jaundice or acute pancreatitis occurred in 4 patients (30.1%). The most frequent cause was anastomosis inflammation (6 patients). Only 2 patients required surgery. Most patients with ALS were treated conservatively with or without percutaneous transhepatic biliary drainage (PTBD). Clinical suspicion is of significant importance because ALS is not common and the symptoms are nonspecific. ALS occurs more frequently in low BMI patients than high. PTBD can be considered as a primary treatment option for ALS if rupture of the afferent loop is not present.
Management of afferent loop syndrome after Roux-en-Y subtotal gastrectomy and choledocolithiasis with recurrent cholangitis