Jejunal Interposition as a Reconstruction for Radical Distal Gastrectomy

To compare the postoperative status between Billroth-I anastomosis and jejunal interposition after distal gastrectomy for gastric cancer, patients were divided, according to the method of surgery, into three groups as follows: 1) extensive nodal dissection and subtotal gastrectomy with jejunal interposition (Group A), 2) the same dissection and gastrectomy as Group A but reconstructed by Billroth-I (Group B), 3) no or slight nodal dissection and partial gastrectomy with Billroth-I anastomosis (Group C). Endoscopy was conducted postoperatively and yielded the following results. Bile reflux and remnant gastritis were not seen at all in Group A, while they were obvious in Group B (52.6%, 57.9%, respectively) and in Group C (33.3%, 46.7%). Reflux esophagitis was seen only in Group B and its incidence was 21.1%. Gastro-biliary scintigraphy was conducted to determine RI reflux to the stomach, which was seen in 8.3% of Group A patients and in 40.0% of Group B patients. His angle was calculated from postoperative UGI series and was the smallest in Group A (97°) while it was 133° in Group B and 105° in Group C. Intraluminal pressure of LES was also studied and was 13.5 cm H2O in Group A and 11.8cm H2O in Grout B. Postoperative complaints were investigated by interview. Weight loss, reflux esophagitis and dumping were the highest in Group B (15.6%, 26.7%, 20.0%, respectively) in comparison with Group A (6.4%, 6.3%, 6.3%) and Group C (5.7%, 0%, 0%). Operating time in Group A was about one hour longer than in Group B; however, there was no difference in incidence of anastomotic leakage and of postoperative intestinal obstruction.