Influence of digestive tract reconstruction techniques on plasma ghrelin level and body mass index after subtotal gastrectomy

Abstract

To study the impact of digestive tract reconstruction techniques on plasma ghrelin level and body mass index (BMI) after subtotal gastrectomy. Eighty-one patients undergoing subtotal gastrectomy for T1-3N0M0 gastric cancer were divided into three groups according to digestive tract reconstruction techniques, which included Billroth I group (n=30), Billroth II group (n=25) and Roux-en-Y group(n=26). Plasma ghrelin level was determined by radioimmunoassay preoperatively and one day, one week, half a year, and one year after gastrectomy. BMI was similarly recorded. Plasma ghrelin levels of three groups decreased sharply to nadir one day after operation, which were (34.2±5.2)%, (37.7±4.7)% and (36.5±4.9)% respectively. A week after operation they were (52.6±6.5)%, (48.3±5.7)% and (48.1±6.0)%. There were no statistical difference between groups (P=0.075). Half a year postoperatively, they were (91.7±7.5)%, (80.4±8.1)% and (75.3±8.3)% and a year postoperatively(95.3±5.1)%, (84.5±6.3)% and (79.9±6.7)%, showing that Billroth I group was obviously higher than the other two groups (P<0.01) and Billroth II group was higher than Roux-en-Y group (P<0.05). BMI of three groups at a year after surgery descended by (2.1±1.1)%, (4.5±1.9)% and (5.7±1.8)% respectively, demonstrating statistical difference. Linear regression correlation existed in the three groups between decreasing amplitude of ghrelin and BMI (P<0.01). Billroth I digestive tract reconstruction takes on the normal anatomy and physiology and therefore promotes compensatory ghrelin secretion. Falling of ghrelin level greatly contributes to the weight loss after subtotal gastrectomy.