Scholar: Lone, Irshad
Guide:
Naqash, Sameer H., Shah, Altaf
Title: Comparative study of reconstructive procedures after distal
gastrectomy for carcinoma stomach: Jejunal interposition with
Billroth I and Billroth II
Keywords: Stomach Cancer; Distal Gastrectomy
Degree: M.S
Year:
2009
Institution: Dept of General Surgery,
Sher-i-Kashmir Institute of Medical Sciences.
Abstract
Objectives: The objective of this study was to evaluate the nutritional benefits of jejunal
interposition against Billroth I and Billroth II and to compare operative time and
postoperative complications.
Study design: Prospective randomized study.
Methods: This study included 45 patients who underwent distal gastrectomy for Ca
stomach. Patients were divided into three groups randomly. Group A included 15 patients
with reconstruction by jejunal interposition, group B included 15 patients reconstructed
by Billroth I gastroduodenostomy and group C included 15 patients reconstructed by
Billroth II gastrojejunostomy. Gastrointestinal continuity was restored by hand-sewn
anastomosis in one layer traversing through all coats.
Results: Maximum incidence of the disease in our series was in the age group 60-70
years. Males were commonly affected with the male to female ratio of 5.4:1. The mean
operating time in jejunal interposition group was longer than Billroth I and Billroth II
procedures (256, 195, 209 mins respectively). No serious postoperative complications
occurred in either group. Weight loss was observed in all the three groups postoperatively
although it was less in jejunal interposition group. Regarding serum nutritional
parameters there was significant improvement in haemoglobin, serum cholesterol, blood
glucose, total protein, serum albumin, serum iron and B12 levels.
Conclusions: Jejunal interposition after distal gastrectomy can recover physiological
continuity of digestive tract and improve quality of life without complications.
Significant advantage of the new procedure was observed in terms of nutritional status.