Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Mar 20, 2024; 14(1): 89709
Published online Mar 20, 2024. doi: 10.5662/wjm.v14.i1.89709
Billroth II anastomosis combined with brown anastomosis reduce reflux gastritis in gastric cancer patients
Grigorios Christodoulidis, Marina Nektaria Kouliou, Konstantinos Eleftherios Koumarelas, Konstantinos Argyriou, Garyfallia Apostolia Karali, Konstantinos Tepetes
Grigorios Christodoulidis, Marina Nektaria Kouliou, Konstantinos Eleftherios Koumarelas, Garyfallia Apostolia Karali, Konstantinos Tepetes, Department of General Surgery, University Hospital of Larissa, Larissa 41110, Greece
Konstantinos Argyriou, Department of Gastroenterology, University Hospital of Larissa, Larissa 41334, Greece
Author contributions: Tepetes K and Christodoulidis G designed the study; Christodoulidis G, Kouliou MN, Koumarelas KE, and Karali O collected the data; Kouliou MN, Koumarelas KE, and Karali O wrote the manuscript; Argyriou K performed the statistical analysis and contributed to the analysis; Tepetes K, Christodoulidis G, and Argyriou K supervised the report.
Institutional review board statement: Due to the retrospective nature of our study, we didn’t require approval by the institution.
Informed consent statement: The informed consent statement is not required due to the retrospective nature of our study.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Data is available from the corresponding author at gregsurg@yahoo.gr.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Grigorios Christodoulidis, MD, PhD, Surgeon, Department of General Surgery, University Hospital of Larissa, Mezourlo, Larissa 41110, Greece. gregsurg@yahoo.gr
Received: November 9, 2023
Peer-review started: November 9, 2023
First decision: December 12, 2023
Revised: December 21, 2023
Accepted: January 24, 2024
Article in press: January 24, 2024
Published online: March 20, 2024
Abstract
BACKGROUND

The surgeon performing a distal gastrectomy, has an arsenal of reconstruction techniques at his disposal, Billroth II among them. Braun anastomosis performed during a Billroth II procedure has shown evidence of superiority over typical Billroth II, in terms of survival, with no impact on postoperative morbidity and mortality.

AIM

To compare Billroth II vs Billroth II and Braun following distal gastrectomy, regarding their postoperative course.

METHODS

Patients who underwent distal gastrectomy during 2002-2021, were separated into two groups, depending on the surgical technique used (Billroth II: 74 patients and Billroth II and Braun: 28 patients). The daily output of the nasogastric tube (NGT), the postoperative day that NGT was removed and the day the patient started per os feeding were recorded. Postoperative complications were at the same time noted. Data were then statistically analyzed.

RESULTS

There was difference in the mean NGT removal day and the mean start feeding day. Mean total postoperative NGT output was lower in Braun group (399.17 mL vs 1102.78 mL) and it was statistically significant (P < 0.0001). Mean daily postoperative NGT output was also statistically significantly lower in Braun group. According to the postoperative follow up 40 patient experienced bile reflux and alkaline gastritis from the Billroth II group, while 9 patients who underwent Billroth II and Braun anastomosis were presented with the same conditions (P < 0.05).

CONCLUSION

There was evidence of superiority of Billroth II and Braun vs typical Billroth II in terms of bile reflux, alkaline gastritis and NGT output.

Keywords: Billroth II, Billroth II and Braun, Reconstruction techniques, Gastrectomy, Distal gastrectomy

Core Tip: This is a retrospective study to evaluate the efficacy of the addition of Braun enteroenteroanastomosis to Bilroth II reconstruction compared to Billroth II alone in terms of the postoperative outcomes of these surgical techniques, following distal gastrectomy. The addition of Braun anastomosis demonstrated superiority in terms of survival without impacting complications or mortality. The study highlights the significance of considering bile reflux and alkaline gastritis in postoperative quality of life after gastrectomy, emphasizing the role of Braun’s anastomosis in reducing bile reflux and associated complications.