Bleeding Ulcer at Braun Anastomosis in Distal Gastrectomy Billroth II Reconstruction: A Case Report

140 Background: Laparoscopic gastrectomy has been proposed as a procedure to reduce the morbidity of gastric cancer surgery. Modified Billroth II (BII) reconstruction with a side to side loop gastrojejunostomy is technically straightforward to accomplish laparoscopically. To determine the long term morbidity of this reconstruction technique, we performed a quality of life (QOL) analysis of patients undergoing laparoscopic distal gastrectomy with modified BII reconstruction. Methods: Between June 2005 and May 2011, 64 patients underwent laparoscopic distal gastrectomy with modified BII reconstruction at City of Hope Medical Center (COH). Patients alive with no evidence of disease were recruited to participate in the QOL study. The study was approved by the Institutional Research Board of COH. Research subjects completed the EORTC QOL-STO22 instrument which queried patients for post gastrectomy symptoms. Comparison between groups was done using the Student-t test. Results: 33 of 64 patients met the criteria for participation in our QOL study. Of these, 23 patients consented to participate and completed the EORTC QOL-STO22 instrument. Overall, 81% categorized symptoms as occurring “not-at-all” or “a-little” while 19% reported symptoms occurring “quite-a-bit” or “very-much”. Since symptoms could be worse in patients with small gastric pouches, we divided our cohort into two groups, one having at least 70% of the stomach resected (12 patients) and the other having less than 70% of the stomach resected (11 patients). The two groups were compared with respect to symptoms. There was no difference between the groups with respect to dysphasia (p=0.80), pain (p=0.98), reflux (p=0.93), and eating restriction (p=0.33). Overall 78% of patients with a small gastric pouch and 83% of patients with a larger gastric pouch reported these symptoms as occurring “not-at-all” or “a-little”. Conclusions: Laparoscopic distal gastrectomy with modified BII reconstruction resulted in an acceptable morbidity rate with few patients experiencing severe symptoms. Gastric pouch size did not predict symptoms and most patients with a small gastric pouch report excellent QOL.

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Distal Gastrectomy with Billroth II Reconstruction is Associated with Oralization of Gut Microbiome and Intestinal Inflammation: A Proof-of-Concept Study

Annals of Surgical Oncology ◽

10.1245/s10434-020-08678-1 ◽

2020 ◽

Cited By ~ 2

Author(s):

Angela Horvath ◽

Augustinas Bausys ◽

Rasa Sabaliauskaite ◽

Eugenijus Stratilatovas ◽

Sonata Jarmalaite ◽

...

Keyword(s):

Gut Microbiome ◽

Intestinal Inflammation ◽

Distal Gastrectomy ◽

Proof Of Concept ◽

Billroth Ii ◽

Concept Study ◽

Billroth Ii Reconstruction

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Initial outcomes assessment of Billroth II – Braun anastomosis in laparoscopic distal gastrectomy for cancer

Vietnam Journal of Endolaparoscopic Surgery ◽

10.51199/vjsel.2021.2.6 ◽

2021 ◽

Vol 11 (2) ◽

Author(s):

Ngọc Hùng Đặng ◽

Keyword(s):

Gastric Cancer ◽

Medical Treatment ◽

Distal Gastrectomy ◽

Good Choice ◽

Laparoscopic Distal Gastrectomy ◽

Common Disease ◽

Billroth Ii ◽

Digestive Cancers ◽

Postoperative Symptoms ◽

Braun Anastomosis

Abstract Introduction: Gastric cancer is a common disease in the world, among the leading digestive cancers. Until now, surgery, especially laparoscopic surgery, is the primary radical treatment. In there, reestablishment of the gastrointestinal continuity remains controversial. Patients and Methods: A prospective study on 42 patients who underwent laparoscopic distal gastrectomy with Billroth II – Braun anastomosis from October 2019 to June 2020. Results: The post-gastrectomy syndrome with persistent diarrhea accounted for 9.52%; alkaline gastritis accounted for 4.76%. Patients with Grade 2 according to Clavien - Dindo classification accounted for 14.28%. Most patients were with good surgical results of VISICK I (71.44%). 14.28% was with quite good results (VISICK II) and moderate results accounted for 14.28% (VISICK III). There was no case of persistent medical treatment or reoperation. Conclusions: Billroth II - Braun anastomosis is a good choice in laparoscopic distal gastrectomy for cancer with low rate of complications and mild postoperative symptoms that could be easily controlled with short-term medical treatment. Key word: Billroth II – Braun, gastric cancer, distal gastrectomy. Tóm tắt Đặt vấn đề: Ung thư dạ dày là bệnh lý thường gặp trên thế giới, đứng hàng đầu trong các ung thư tiêu hóa. Hiện nay, điều trị ung thư dạ dày (UTDD) bằng phẫu thuật, đặc biệt phẫu thuật nội soi, là phương pháp điều trị triệt căn hàng đầu. Trong đó, tái lập lưu thông tiêu hóa là vấn đề còn đang thảo luận. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả tiến cứu trên 42 người bệnh (NB) UTDD được cắt bán phần dạ dày phần xa bằng phẫu thuật nội soi (PTNS), tái lập bằng miệng nối bilroth II - Braun từ tháng 10/2019 đến tháng 6/2020 và đánh giá kết quả miệng nối Bilroth II (polyA) - Braun trong tái lập lưu thông tiêu hóa sau cắt bán phần xa dạ dày nội soi do ung thư. Kết quả: Hội chứng sau cắt dạ dày với tiêu chảy kéo dài tỷ lệ 9,52%; viêm dạ dày do kiềm chiếm 4,76%. Các NB có độ 2 theo Clavien - Dindo là 14,28%. Phần lớn BN có kết quả phẫu thuật tốt đạt VISICK I (71,44%). 14,28% đạt kết quả khá (VISICK II) và kết quả trung bình là 14,28% (VISICK III). Không có trường hợp cần dùng thuốc dài ngày hay mổ lại. Kết luận: Miệng nối Bilroth II - Braun là một lựa chọn tốt trong phẫu thuật cắt bán phần xa dạ dày do ung thư với tỷ lệ biến chứng sau mổ thấp và các triệu chứng mắc phải sau phẫu thuật thường nhẹ, có thể dễ dàng kiểm soát bằng điều trị nội khoa ngắn ngày. Từ khóa: Billroth II - Braun, ung thư dạ dày, cắt bán phần dạ dày.

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