Options and clinical evaluation of digestive tract reconstruction after distal gastrectomy for gastric cancer

Abstract

Digestive tract reconstruction after distal gastrectomy for gastric cancer includes Billroth Ⅰ (BⅠ), Billroth Ⅱ (BⅡ), Roux-en-Y (RY), uncut-RY, RY-double tract (DT) and jejunal interposition (JI). BⅠreconstruction is the most common method, with an advantage of keeping normal duodenal pathway for food. The disadvantage of BⅡ reconstruction is that it could cause dumping syndrome-related syndroms compared with RY reconstruction. RY reconstruction was not superior to BⅠ reconstruction in terms of keeping body weight and improving nutritional status, although it could significantly decrease the incidences of reflux residual gastritis and reflux esophagitis. Uncut-RY reconstruction is better than Roux-en-Y reconstruction in the prevention of Roux stasis syndrome. DT reconstruction has not only the advantages of descending the incidences of reflux residual gastritis and reflux esophagitis but also kept the normal duodenal pathway for food. JI is feasible and safe with the advantages as mentioned above, however, it has complicated surgical process and time-consuming, and anastomotic ulcer may occur after the surgery. Key words: Gastric neoplasms; Distal gastrectomy; Digestive tract reconstruction