[Reconstruction following distal gastrectomy: Billroth or Roux?]

Since the first gastric resection performed by Theodor Billroth in 1881, there has been discussion about the best method of reconstruction following gastric resection. Because of its high incidence of anastomotic ulcers, the method of Roux-en-Y reconstruction was abandoned at the beginning of the 20th century. In the late 1970s, when the first gastric stump carcinomas became known, Roux-en-Y reconstruction rose to become the method of choice for reconstruction following gastric resection. The main advantage of the method is in preventing high gastroduodenal reflux and thus averting the development of gastric stump carcinoma. When it is combined with total antrectomy and vagotomy, the rate of anastomotic ulcers is negligible and patients benefit from an improved longterm functional result.