Comparison of Billroth I and Billroth II reconstructions after laparoscopy-assisted distal gastrectomy: a retrospective analysis of large-scale multicenter results from Korea

Abstract

Background Since reconstruction after laparoscopyassisted distal gastrectomy (LADG) is performed through a small minilaparotomy window, the clinical course and complication rate are influenced by clinical technical expertise and experience. The aim of this study was to compare postoperative complications and survival rates of Billroth I and Billroth II reconstructions after LADG. Patients and methods We retrospectively collected data from 1,259 patients who underwent LADG performed by ten surgeons at ten hospitals between April 1998 and December 2005. Patients were classified into two groups according to reconstruction method used: the Billroth I group (n = 875) and the Billroth II group (n = 384). Patient and tumor characteristics, operative details, and postoperative complications were analyzed.Results Billroth II reconstruction was performed on obese patients (p = 0.003) and patients with more advanced tumors (p \ 0.001). Billroth I reconstruction was performed more frequently in the lower portion of the stomach (p \ 0.001) and yielded shorter operating times. The postoperative complication rate was 11.4% in the Billroth I group, which was lower than that in the Billroth II group (16.9%) (p = 0.011). However, the differences in the major complication rates were not statistically significant (p = 0.263). Of the intra-abdominal complications, intraluminal or intraperitoneal bleeding was the most frequent complication in the Billroth I group and duodenal stump leakage was the most frequent in the Billroth II group. The postoperative mortality rate did not show a statistically significant difference.

Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis

“…Among the remaining articles, 19 studies [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] were excluded because EGC cases were mixed with AGCs in the cohort studies and data on AGCs were not extractable. Eight studies were further deleted for the following reasons: 2 studies were ongoing randomized controlled trials (RCTs) that only described study design and patient enrollment criteria without results reported [56,57]; 2 studies had overlapped enrollments with former research [58,59]; 1 study reported incomplete data that were not suitable for analysis [60]; and 3 studies discussed other issues irrelevant to the topic of this meta-analysis [61][62][63]. Finally, a total of 26 studies that compared the short-term and/or long-term results of AGCs treated by LG with those of OG were included .…”

Intra-abdominal infectious complications following gastrectomy in patients with excessive visceral fat

“…To date, the risk factors for anastomotic leakage after gastrectomy have not been completely clarified [26]. Both Ser et al [27] and Kang et al [28] have reported that anastomotic leakage may occur in cases in which there is excess tension and pressure on the anastomotic site and that these conditions are more frequently observed in patients with excessive visceral fat because the thick mesentery creates tension on the anastomosis. In addition, a deeper surgical field in these patients, and preoperative comorbidities, such as cardiovascular disease or diabetes mellitus, which are frequently seen in obese patients, may affect the development of anastomotic leakage [29][30][31].…”

Comparison of laparoscopy-assisted and totally laparoscopic Billroth-II distal gastrectomy for gastric cancer

“…However, this procedure requires multiple anastomosis and involves a risk of Roux stasis. For food stasis, this procedure is stressful to both patients and surgeons, and most Korean surgeons have been reluctant to perform this procedure [6,19]. …”