Braun Anastomosis Research Articles

Comparison between laparoscopic uncut Roux-en-Y and Billroth II with Braun anastomosis after distal gastrectomy: A meta-analysis.

BACKGROUNDConventional Billroth II (BII) anastomosis after laparoscopic distal gastrectomy (LDG) for gastric cancer (GC) is associated with bile reflux gastritis, and Roux-en-Y anastomosis is associated with Roux-Y stasis syndrome (RSS). The uncut Roux-en-Y (URY) gastrojejunostomy reduces these complications by blocking the entry of bile and pancreatic juice into the residual stomach and preserving the impulse originating from the duodenum, while BII with Braun (BB) anastomosis reduces the postoperative biliary reflux without RSS. Therefore, the purpose of this study was to compare the efficacy and safety of laparoscopic URY with BB anastomosis in patients with GC who underwent radical distal gastrectomy.AIMTo evaluate the value of URY in patients with GC.METHODSPubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Database, and VIP Database for Chinese Technical Periodicals (VIP) were used to search relevant studies published from January 1994 to August 18, 2021. The following databases were also used in our search: Clinicaltrials.gov, Data Archiving and Networked Services, the World Health Organization International Clinical Trials Registry Platform Search Portal (https://www.who.int/clinical-trials-registry-platform/the-ictrp-search-portal), the reference lists of articles and relevant conference proceedings in August 2021. In addition, we conducted a relevant search by Reference Citation Analysis (RCA) (https://www.referencecitationanalysis.com). We cited high-quality references using its results analysis functionality. The methodological quality of the eligible randomized clinical trials (RCTs) was evaluated using the Cochrane Risk of Bias Tool, and the non-RCTs were evaluated using the Newcastle-Ottawa scale. Statistical analyses were performed using Review Manager (Version 5.4). RESULTSEight studies involving 704 patients were included in this meta-analysis. The incidence of reflux gastritis [odds ratio = 0.07, 95% confidence interval (CI): 0.03-0.19, P < 0.00001] was significantly lower in the URY group than in the BB group. The pH of the postoperative gastric fluid was lower in the URY group than in the BB group at 1 d [mean difference (MD) = -2.03, 95%CI: (-2.73)-(-1.32), P < 0.00001] and 3 d [MD = -2.03, 95%CI: (-2.57)-(-2.03), P < 0.00001] after the operation. However, no significant difference in all the intraoperative outcomes was found between the two groups.CONCLUSIONThis work suggests that URY is superior to BB in gastrointestinal reconstruction after LDG when considering postoperative outcomes.

Does the addition of Braun anastomosis to Billroth II reconstruction on laparoscopic-assisted distal gastrectomy benefit patients?

BACKGROUNDOperation is the primary therapeutic option for patients with distal gastrectomy. Braun anastomosis is usually performed after Billroth II reconstruction, which is wildly applied on distal gastrectomy because it is believed to benefit patients. However, studies are needed to confirm that.AIMTo identify whether the addition of Braun anastomosis to Billroth II reconstruction on laparoscopy-assisted distal gastrectomy benefits patients.METHODSA total of 143 patients with gastric cancer underwent laparoscopy-assisted distal gastrectomy at Centre 1 of PLA general hospital between January 2015 and December 2019. Clinical data of the patients were collected, and 93 of the 143 patients were followed up. These 93 patients were divided into two groups: Group 1 (Billroth II reconstruction, 33 patients); and Group 2 (Billroth II reconstruction combined with Braun anastomosis, 60 patients). Postoperative complication follow-up data and relevant clinical data were compared between the two groups.RESULTSThere were no significant differences between Group 1 and Group 2 in postoperative complications (6.1% vs 6.7%, P = 0.679), anal exhaust time or blood loss. The follow-up prevalence of reflux gastritis indicated no significant difference between Group 1 and Group 2 (68.2% vs 51.7%, P = 0.109). The follow-up European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 scores revealed no evident difference between Group 1 and Group 2 as well. Group 1 had a shorter operating time than Group 2 on average (234.6 min vs 262.0 min, P = 0.017).CONCLUSIONCombined with Billroth II reconstruction, Braun anastomosis has been applied due to its ability to reduce the prevalence of reflux gastritis. Whereas in this study, the prevalence of reflux gastritis showed no significant difference, leading to a conclusion that under the circumstance of Braun anastomosis costing more time and more money, simple Billroth II reconstruction should be widely applied.

A 3-year follow-up study of uncut Roux-en-Y reconstruction: clinical results and outcomes.

The goal of this study was to identify the clinical outcomes of uncut Roux-en-Y reconstruction in patients who underwent totally laparoscopic distal gastrectomy (TLDG) over 3-year follow-up. From January 2016 to December 2017, 269 patients who underwent TLDG were enrolled in the study and analyzed retrospectively. They were classified into two groups according to the reconstruction method: uncut Roux-en-Y reconstruction (uncut RY) (n = 154) and Billroth II with Braun anastomosis (B-II/Braun) (n = 115). Postoperative endoscopic findings (residual food, bile reflux, gastritis, and esophagitis) and nutritional status (body weight, serum hemoglobin, total protein, and albumin levels) were assessed every 6months for 3years. Residual food was less frequent in the uncut RY group in the 6th month after TLDG (p = 0.022), but there were no differences between the two groups for the rest of the study period. The incidence of bile reflux and gastritis was low in the uncut RY group during all postoperative periods (all p &lt; 0.001). In the B-II/Braun group, the frequency of reflux esophagitis was high in the 30th and 36th months after TLDG (both p &lt; 0.001), and there were no differences between the two groups during the preceding periods. No significant differences were found with respect to nutritional status, such as body weight, serum hemoglobin, total protein, and albumin levels during all postoperative periods. Three-year follow-up outcomes showed that uncut RY can effectively reduce the incidence of bile reflux and gastritis in the remnant stomach compared to B-II/Braun after TLDG.

Comparison between Roux-en-Y gastrojejunostomy and Billroth-II with Braun anastomosis following partial gastrectomy: A randomized controlled trial

Partial gastrectomy surgeries are conducted frequently due to various reasons but there is no consensus regarding the method of choice for gastrointestinal reconstruction. In this study we aimed to compare Billroth II with Braun anastomosis and Roux-en-Y gastrojejunostomy. This randomized, Single-blind clinical trial was conducted on patients presented to surgery clinic at Besat and Taleghani hospital between 2018 and 2020 who were gastrectomy candidates. Patients undergoing Billroth II reconstruction with Braun anastomosis or Roux-en-Y gastrojejunostomy were enrolled in the study. Demographics, operation durative and intraoperative blood loss, early postoperative complications, re-admission within 30 days post operation, 30-day and 90-day mortality were recorded. at an at least 3-month post-surgery period, patients were followed for late postoperative complications. If necessary, endoscopy was conducted and biopsy was taken. Analysis was performed with SPSS version 22. A total of 84 patients in two 42-patient groups were evaluated. All parameters were the same in two groups except operation duration and intraoperative bleeding (significantly higher in RY group), food residue (significantly higher in RY group) and bile in remnant stomach (significantly higher in B2B group). These two methods of reconstruction are comparable in terms of postoperative complications and mortality rates. Food residue and bile reflux are two determinants which should be kept in mind when choosing the surgery plan by surgeons.This trial was prospectively registered in the Iranian Registry of Clinical Trials with a registration ID of IRCT20130706013875N3.

Comparison of clinical efficacy and quality of life between uncut Roux-en-Y and Billroth II with Braun anastomosis in laparoscopic distal gastrectomy for gastric cancer

Objective: To compare the clinical efficacy and quality of life between uncut Roux-en-Y and Billroth II with Braun anastomosis in laparoscopic distal gastrectomy for gastric cancer patients. Methods: A retrospective cohort study was performed. Inclusion criteria: (1) 18 to 75 years old; (2) gastric cancer proved by preoperative gastroscopy, CT and pathological results and tumor was suitable for D2 radical distal gastrectomy; (3) postoperative pathological diagnosis stage was T1-4aN0-3M0 (according to the AJCC-7th TNM tumor stage), and the margin was negative; (4) Eastern Cooperative Oncology Group (ECOG) physical status score <2 points, and American Association of Anesthesiologists (ASA) grade 1 to 3; (5) no mental illness; (6) able to answer questionnaires independently; (7) patients agreed to undergo laparoscopic distal gastrectomy and signed an informed consent. Exclusion criteria: (1) patients with severe chronic diseases and American Association of Anesthesiologists (ASA) grade >3; (2) patients with other malignant tumors; (3) patients suffered from serious mental diseases; (4) patients received neoadjuvant chemotherapy or immunotherapy. According to the above criteria, clinical data of 200 patients who underwent laparoscopic distal gastrectomy at the Department of General Surgery of the First Affiliated Hospital of Army Medical University from January 2016 to December 2019 were collected. Of the 200 patients, 108 underwent uncut Roux-en-Y anastomosis and 92 underwent Billroth II with Braun anastomosis. The general data, intraoperative and postoperative conditions, complications, and endoscopic evaluation 1 year after the surgery were compared. Besides, the quality of life of two groups was also compared using the Chinese version of the European Organization For Research and Treatment of Cancer (EORTC) quality of life questionnaire-Core 30 (QLQ-C30) and quality of life questionnaire-stomach 22 (QLQ-STO22). Results: There were no significant differences in baseline data between the two groups (all P>0.05). All the 200 patients successfully underwent laparoscopic distal gastrectomy without intraoperative complications, conversion to open surgery or perioperative death. There were no significant differences between two groups in operative time, intraoperative blood loss, postoperative complications, time to flatus, time to removal of gastric tube, time to liquid diet, time to removal of drainage tube or length of postoperative hospital stay (all P>0.05). Endoscopic evaluation was conducted 1 year after surgery. Compared to Billroth II with Braun group, the uncut Roux-en-Y group had a significantly lower incidences of gastric stasis [19.8% (17/86) vs. 37.0% (27/73), χ(2)=11.199, P=0.024], gastritis [11.6% (10/86) vs. 34.2% (25/73), χ(2)=20.892, P<0.001] and bile reflux [1.2% (1/86) vs. 28.8% (21/73), χ(2)=25.237, P<0.001], and the differences were statistically significant. The EORTC questionnaire was performed 1 year after surgery, there were no significant differences in the scores of QLQ-C30 scale between the two groups (all P>0.05), while the scores of QLQ-STO22 showed that, compared to the Billroth II with Braun group, the uncut Roux-en-Y group had a lower pain score (median: 8.3 vs. 16.7, Z=-2.342, P=0.019) and reflux score (median: 0 vs 5.6, Z=-2.284, P=0.022), and the differences were statistically significant (all P<0.05), indicating milder symptoms. Conclusion: The uncut Roux-en-Y anastomosis is safe and reliable in laparoscopic distal gastrectomy, which can reduce the incidences of gastric stasis, gastritis and bile reflux, and improve the quality of life of patients after surgery.

A Modified Billroth-II with Braun Anastomosis in Totally Laparoscopic Distal Gastrectomy: Initial Experience Compared with Roux-en-Y Anastomosis.

This retrospective study aimed to compare the feasibility and effectiveness of a modified Billroth-II with Braun (B-II Braun) reconstruction and those of a Roux-en-Y (R-Y) reconstruction after laparoscopic distal gastrectomy. From January 2016 to December 2019, 247 patients underwent total laparoscopic distal gastrectomy (TLDG), with B-II Braun reconstruction for 145 patients and R-Y reconstruction for 102 patients. The patients' data were collected prospectively and reviewed retrospectively. In this study, the median times of the operation were statistically shorter for B-II Braun than for R-Y (167 min [range, 110-331min] vs 191min [range, 123-384min]; p = 0.001), including anastomotic times (33min [range, 30-42min] vs 42min [range, 40-48min]; p = 0.001). After a short-term follow-up period, endoscopy showed 31 cases of bile reflux (21.4%), 15 cases of grade 2 gastritis (10.3%), and 6 cases of grade 2 food residue (4.1%) in the B-II Braun group after 6months. After 1year, 10 patients (6.9%) had grade 2 gastritis and 2 patients (1.4%) had grade 3 gastritis. However, the remnant stomach of the two groups did not differ significantly in the rate of gastric residue (p = 0.112 after 6months; p = 0.579 after 1year, respectively), gastritis (p = 0.726 after 6months; p = 0.261 after 1year, respectively), or bile reflux (p = 0.262 after 6months; p = 0.349 after 1year, respectively). For gastric cancer patients, TLDG with modified B-II Braun reconstruction could be technically feasible. It has an acceptable range of postoperative complications and is effective in preventing bile reflux into the gastric remnant.

ASO Visual Abstract: A Modified Billroth-II with Braun Anastomosis in Totally Laparoscopic Distal Gastrectomy—Initial Experience Compared with Roux-en-Y Anastomosis

ASO Visual Abstract: A Modified Billroth-II with Braun Anastomosis in Totally Laparoscopic Distal Gastrectomy—Initial Experience Compared with Roux-en-Y Anastomosis

EVALUATION OF RESULTS OF ERAS PROGRAM AFTER PANCREATODUODENECTOMY DEPENDING ON THE TYPE OF GASTROINTESTINAL RECONSTRUCTION

The aim: To assess the effect of gastrojejunostomy with Braun anastomosis during PD for prevention of DGE in ERAS protocol patients. Materials and methods: A total of 92 patients from 28 to 75 years were included in this study, who underwent PD with ERAS program. Patients were divided into 2 groups, depending on type of reconstruction - PD with Child reconstruction and PD with gastrojejunostomy with Braun anastomosis. Results: In non-Braun group nasogastric tube was removed on POD 1 in 56 (93.3%) patients and was reinserted later in 4 (6.7%) patients. DGE was observed in 8 (13,3%) patients, which required enteral feeding via nasojejunal tube. In 51 (85.0%) patients feeding was started according to ERAS program without the need for other methods of nutritional support. In Braun group nasogastric tube was removed on POD 1 in all patients after the X-ray control and oral feeding was started. Due to the development of DGE, a nasojejunal tube for enteral nutrition was placed in two cases. In 30 (93,7%) patients peroral feeding was started in accordance to enhanced recovery program. Thus, the frequency of DGE in group II was lower (6.3%), but the difference did not reach statistical significance (p = 0.299). Conclusions: The formation of a Braun anastomosis in PD with the use of ERAS program can reduce the frequency of DGE and eliminate the consequences of technical errors. More studies are needed for stronger evidence.

Effects of different gastrointestinal reconstruction techniques on nutrition, anemia, and quality of life in laparoscopic distal gastrectomy for gastric cancer.

ABSTRACTPurpose:To explore the effect of different gastrointestinal reconstruction techniques on laparoscopic distal gastrectomy of gastric cancer on the nutritional and anemia status, and quality of life (QoL) of patients.Methods:Eligible patients were randomly divided into three groups (n=36/group): Billroth I anastomosis group, Billroth II combined with Braun anastomosis group, and Roux-en-Y anastomosis group. Related indicators were compared and analyzed.Results:The general data were comparable among the three groups (all P>0.05). Among the surgical-related indicators and postoperative recovery indicators, only the comparison of the operation time was statistically significant (P=0.004). The follow-up time was 5~36 months (average 27.9 months). In terms of nutritional and anemia indicators, only the differences in the levels of prealbumin, hemoglobin and serum ferritin in 24 months after operation showed significant differences (P=0.015, P=0.003, P=0.005, respectively). There were no significant differences in hospital readmission rate, overall survival, and QoL among the three groups (all P>0.05).Conclusions:In laparoscopic gastrectomy for stage II~III distal gastric cancer, Billroth I anastomosis has shorter operation time than Billroth II combined with Braun anastomosis and Roux-en-Y anastomosis and advantages in the improvement of nutritional status and anemia recovery.

Common Bile Duct Dilatation According to the Type of Reconstruction after Gastrectomy for Gastric Cancer

Introduction: There are many studies for the increased incidence for choledocholithiasis and common bile duct dilatation after gastrectomy. However, there are few reports about the dilatation of common bile duct (CBD) according to the type of anastomosis in patients undergoing gastrectomy for gastric cancer. The aim of this study was to evaluate the degree of CBD dilation in patients who underwent subtotal gastrectomy with various anastomosis using 1-year follow-up abdominal CT scan. Methods: From January 2012 to December 2015, 395 patients who underwent subtotal total gastrectomy for gastric cancer and had no gallstones were enrolled. We measured CBD diameter in the pancreas head by analyzing preoperative, 6-, and 12- months follow-up abdomen-pelvis enhanced computed tomography (A-P CT) scans. Results: The CBD was dilated slightly from 4.1 mm at baseline to 5.1 mm at 6 months and 6.1 mm at 12 months after gastrectomy. The number of cases of CBD dilatation of more than 7 mm at 6 months and at 12 months after cholecystectomy were 11 (24.4%) and 9 (29.0%), respectively. Seven cases at 6 months and 5 cases at 12 months showed bile duct dilation of more than 3 mm compared to baseline. There were no cases having bile duct dilation of more than 10 mm. Conclusions: The diameter of CBD was significantly increased after subtotal or total gastrectomy. In addition, the degree of dilation of CBD was higher after not only Billroth-II with Braun anastomosis but Roux-en Y anastomosis compared to Billroth-I.

Sleeve Gastrectomy with Braun Anastomosis Transit Bipartition (B-TB): a Potential Midway Between Single Anastomosis and Roux-en-Y Transit Bipartition.

The single anastomosis sleeve ileal bypass (SASI) procedure is a simple modification of the Roux-en-Y transit bipartition (RYTB) procedure; however, SASI risks patients with possible biliary reflux. Braun anastomosis has been proposed to fix the biliary reflux of single anastomosis procedures. This study presented our early "sleeve gastrectomy with Braun anastomosis Transit Bipartition" (B-TB) outcomes. Patients who underwent B-TB or RYTB between June 2020 and April 2021 at our hospital and have completed three months follow-up were included in this study. Ten patients with B-TB and forty patients with RYTB were included. No significant differences were observed between the B-TB and RYTB patients regarding the preoperative conditions. The B-TB procedure had significantly shorter operation time and postoperative hospitalization time than the RYTB procedure. There was no significant difference between the two groups regarding the 3-month percentage of total weight loss (B-TB vs RYTB: 19.7 ± 2.7% vs 22.2 ± 5.4%) and the postoperative complications before discharge. Preoperatively, two patients and eight patients achieved GERD-Q score ≥8 for the B-TB and RYTB group, respectively. At postoperative 3 months, those with GERD-Q score ≥8 was reduced to one patient and two patients for the B-TB and RYTB group, respectively. No patients have reported symptoms of greenish-yellow vomiting in both groups postoperatively. B-TB is an exciting procedure with potential benefits. However, as it is an investigational procedure, extra care should be maintained. Larger samples and more extended follow-up data are needed in the future.

Клинический случай операции гастроэнтеростомии с брауновским соустьем под эпидуральной анестезией

В статье описан клинический случай операции гастроэнтеростомии, выполненной под эпидуральной анестезией с внутривенным потенцированием кетамином, у больного с ишемической болезнью сердца, АВ-блокадой ІІІ ст., имплантированным электрокардиостимулятором.

GASTRIC OUTLET OBSTRUCTION POST ACID INGESTION IN PEDIATRICS

Aim: Evaluate clinical pattern, diagnosis, surgical management and outcome of Gastric outlet obstruction in children post accidental ingestion corrosive (sulfuric acid of battery) , also role of continuing public education to reduce and avoid incidence these unfortunate events. Patients &amp; method: prospective study for 20 patients’ children with isolated gastric outlet obstruction post corrosive sulfuric acid ingestion was admitted and operated in Saudi hospital at Hajjah Yemen in period April 2015_April 2021. The study evaluates patients’ demographic data, clinical presentation, diagnosis and management, also included in this study the Comparison proportions between two surgical procedures used for management this patient (group (A) pyloric resection and gastroduodenostomy and group (B) gastrojejunostomy with Braun anastomosis) with P value &gt;0.05 was non-significant. Results: Twenty patients with gastric outlet obstruction (12 boys and 8 girls), (Mean age was 4.5). Main presenting symptom recurrent attacks vomiting and loss of weight. The interval between acid ingestion and presentation ranged from 3_4weeks(mean=3.5weeks). The History, Barium swallow and meal used as diagnostic tool because safe, inexpensive. Surgical procedure included group (A)pyloric resection and gastroduodenostomy (n=10) and group (B) gastrojejunostomy with Braun anastomosis (n=10). Comparison between the two surgical procedures show all safe, less morbid, no mortality and no significant difference in end outcome result follow-up period up 2 years, all patients are symptoms free and gained adequate weight. Conclusion: for patients children post corrosive accident ingestion with gastric outlet obstruction The History, barium swallow and meal used as diagnostic tool. Early surgery between 4_6 weeks by resection or bypass remains the treatment of choice with best result. To prevent these unfortunate events by encourage the Family education about clear labelling of dangerous substances and keeps this substance Far from reaching the kids. Key word: corrosive induce gastric outlet obstruction; pyloric stricture; gastric outlet obstruction in pediatrics

Chinese expert consensus on intracorporeal digestive reconstruction after robotic gastrectomy (2021 edition)

The robotic surgical system applied to gastrectomy is regarded as a safe technique which has similar short- and long-term outcomes compared to laparoscopic and open gastrectomy. With the iteration of anastomotic staplers and improvement of anastomotic skills, coupled with the flexible robot's rotatable device making the manual intracorporal anastomosis easier, gastrointestinal reconstruction after robotic gastrectomy has also started to move toward the era of complete intracorporal anastomosis. In order to further standardize the indications and operating points, the Upper Gastrointestinal Surgery Group of Surgical Branch of Chinese Medical Doctor Association, the Gastrointestinal Surgery Group of Surgery Branch of Chinese Medical Association, the Digestive Tract Cancer Committee of Chinese Research Hospital Association, and Cancer Gastroenterology Society of Chinese Anticancer Association jointly organized domestic experts in general surgery field to formulate the Chinese expert consensus on intracorporal digestive reconstruction after robotic gastrectomy (2021 edition). The definition of intracorporeal digestive reconstruction after robotic gastrectomy is that all surgical steps of digestive reconstruction are done totally in the abdominal cavity by robotic system or all steps mentioned above except jejunojejunal extracorporeal anastomosis. The digestive reconstructions mainly include Billroth I anastomosis, Billroth II anastomosis, Billroth II+ Braun anastomosis, Roux-en-Y anastomosis, Uncut Roux-en-Y anastomosis after distal gastrectomy; double-tract anastomosis, esophagogastric anastomosis by stapler or hand-sewn technique (double flap gastroesophagostomy) after proximal gastrectomy; FEEA method, π-type anastomosis, overlap method and modified procedures, Uncut Roux-en-Y anastomosis, Parisi's double-loop reconstruction after total gastrectomy. Compared with extracorporeal digestive reconstruction, intracorporeal digestive reconstruction operated by robotic system can minimize the surgical incision, reduce the risk of abdominal exposure and accelerate postoperative recovery, etc. Previous studies have demonstrated promising results. We believe that the publication of the consensus will guide surgeons to break through the technical barriers of intracorporeal digestive reconstruction after robotic gastrectomy, which will be more and more widespread with the gradual maturity of domestic robotic systems by bringing less medical costs.

Effect of Braun anastomosis on delayed gastric emptying after pancreaticoduodenectomy

Objective To investigate the effect of Braun anastomosis (BE) on delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD). Methods A retrospective analysis was performed for the clinical data of 132 patients who underwent PD in The First Hospital of Lanzhou University from December 2016 to December 2019, and according to whether BE was performed during surgery, the patients were divided into BE group with 54 patients and non-BE group with 78 patients. The two groups were compared in terms of postoperative complications (DGE, pancreatic fistula, and biliary fistula), intraoperative condition, general examination indicators, postoperative treatment and recovery, and hospitalization to evaluate the effect of BE in preventing DGE after PD. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test and the Fisher's exact test were used for comparison of categorical data between two groups. Results Compared with the non-BE group, the BE group had a significantly lower incidence rate of grade C DGE after surgery (5.56% vs 19.23%, χ2=5.067, P 0.05). Conclusion BE can effectively reduce the incidence rate of grade C DGE after PD.

Common bile duct dilatation according to the type of anastomsosis after gastrectomy for gatric cancer

There are many studies for the increased incidence for choledocholithiasis and common bile duct (CBD) dilatation after gastrectomy. However, there are few reports about the dilatation of CBD according to the type of anastomosis in patients undergoing gastrectomy for gastric cancer. We compared the changes of CBD diameter after gastrectomy with various anastomosis. The aim of this study was to evaluate the degree of CBD dilation in patients who underwent subtotal gastrectomy with various anastomosis using 1-year follow-up abdominal computed tomography (CT) scan. From January 2012 to December 2015, 395 patients who underwent subtotal total gastrectomy for gastric cancer and had no gallstones were enrolled. We measured CBD diameter in the pancreas head by analyzing preoperative, 6-, and 12-month follow-up abdomen-pelvis enhanced CT (A-P CT) scans. The CBD was dilated slightly from 4.1 mm at baseline to 5.1 mm at 6 months and 6.1 mm at 12 months after gastrectomy. The number of cases of CBD dilatation of more than 7 mm at 6 months and at 12 months after cholecystectomy were 11 (24.4%) and 9 (29.0%), respectively. Seven cases at 6 months and 5 cases at 12 months showed bile duct dilation of more than 3 mm compared to baseline. There were no cases having bile duct dilation of more than 10 mm. The diameter of CBD was significantly increased after subtotal or total gastrectomy. In addition, the degree of dilation of CBD was higher after not only Billroth-II with Braun anastomosis but Roux-en Y anastomosis compared.

Comparison of Roux-en-Y gastrojejunostomy and Billruth-II with Braun anastomosis for gastric reconstruction following partial gastrectomy

Background and aims: Partial gastrectomy surgeries are conducted frequently due to various reasons but there is no consensus regarding the method of choice for gastrointestinal reconstruction. In this study we aimed to compare billruth II with Braun anastomosis and Roux-en-Y gastrojejunostomy. Materials and methods: This prospective study was conducted on patients presented to surgery clinic at Besat and Taleghani hospital between 2018-2020 who were gastrectomy candidates. Patients undergoing Billruth 2 reconstruction with Braun anastomosis or Roux-en-Y gastrojejunostomy were enrolled in the study. Demographics, operation durative and intraoperative blood loss, early postoperative complications, re-admission within 30 days postoperation, 30-day and 90-day mortality were recorded. at an at least 3-month post-surgery period, patients were followed for late postoperative complications. If necessary, endoscopy was conducted and biopsy was taken. Analysis was performed with SPSS version 22. Results: 84 patients in two 42-patient groups were evaluated. All parameters were the same in two groups except operation duration and intraoperative bleeding (significantly higher in RY group), food residue (significantly higher in RY group) and bile in remnant stomach (significantly higher in B2B group). Conclusion: These two methods of reconstruction are comparable in terms of postoperative complications and mortality rates. Food residue and bile reflux are two determinants which should be kept in mind when choosing the surgery plan by surgeons. Keywords: gastrectomy, reconstruction, Billruth, Braun, Roux en Y anastomosis

Clinical case of intussusception of the jejunum into gastroenteroanastomosis after gastric ­resection

Intussusception is one of the varieties of mixed (strangulation and obturation) mechanical intestinal obstruction. It arises as a result of the introduction of the adducting segment of the intestine into the abducting one. Gastroduodenal intussusception is an extremely rare type of high intestinal obstruction. It most often occurs after surgery on the stomach and much less often in non-operated patients. Intussusception of the jejunum into the stomach can occur soon after surgery, but most often, this complication occurs 515 years after the intervention. This paper describes a case of retrograde intussusception that arose 9 years after the Billroth II gastric resection with Braun anastomosis. This clinical case acquaints specialists with the possibility to encounter this pathology in clinical practice and demonstrates the appropriateness of differential diagnostics in cases with similar clinical symptoms.

Internal Hernia within the Mesenteric Gap between a Gastrojejunostomy and a Braun Anastomosis after Subtotal Stomach-preserving Pancreaticoduodenectomy

Internal Hernia within the Mesenteric Gap between a Gastrojejunostomy and a Braun Anastomosis after Subtotal Stomach-preserving Pancreaticoduodenectomy

Truncal Vagotomy, Gastrojejunostomy and Braun Anastomosis Technique in the Surgical Treatment of Intractable Peptic Ulcer

Truncal Vagotomy, Gastrojejunostomy and Braun Anastomosis Technique in the Surgical Treatment of Intractable Peptic Ulcer