Usefulness of pyloric reconstruction without compromising curative resection in gastric cancer treatment

We herein report the short-term results of the newly developed modified technique of Billroth I (modified B-I; pylorus reconstruction) that prevents duodenogastric reflux (DGR) and remnant gastritis after distal gastrectomy.

Distal gastrectomy with this technique was performed in 20 patients (age, 41 to 86 years [mean, 68.5 ± 11.8 years], male/female = 12:8) with gastric cancer from June 2006 through December 2009. These patients were compared with another 20 patients who underwent conventional B-I after distal gastrectomy (age, 41 to 85 years [mean, 69.3 ± 8.69 years], male/female = 11:9). The side effects of gastric surgery evaluated in this study were the degree of remnant gastritis, the presence of dumping syndrome, and the degree of weight loss.

By gastrografin contrast imaging on the fifth day after pylorus reconstruction, the remnant stomach was not dilated and gastrografin flowed physiologically to the duodenum without backward reflux into the remnant stomach. By gastroscopy at 6 months after the operation, DGR and the degree of remnant gastritis after pylorus reconstruction was lower than those of conventional B-I (P = 0.00068). The bile acid concentration of remnant gastric juice of pylorus reconstruction was lower than that of conventional B-I (55.5 ± 93.5 vs. 1,369.5 ± 2,502.1 μmol/L, P = 0.0415). Weight loss at 1 year after distal gastrectomy was less in pylorus reconstruction compared with conventional B-I (6.2 ± 5.2% vs. 9.8 ± 8.7%, P = 0.0725).

Pylorus reconstruction is a simple and safe anastomotic technique that reduces the side effects of B-I reconstruction.