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Surgical options for reconstruction after antrectomy
- Billroth I reconstruction consists of a gastroduodenostomy in which the anastomosis is created between the gastric remnant and the duodenum
- Billroth II reconstruction consists of a gastrojejunostomy in which a side-to-side anastomosis is created between the gastric remnant and a loop of jejunum, with closure of the duodenal stump
- Roux-en-Y reconstruction involves the creation of a jejunojejunostomy (forming a Y-shaped figure of small bowel) downstream from the anastomosis of the free jejunal end to the gastric remnant (gastrojejunostomy).
How is the type of reconstruction determined for a given patient?
- The decision of which type of reconstruction to perform is determined, in large part, by the extent of duodenal scarring caused by PUD and the ease with which the duodenum and the stomach can be brought together.
- Severely scarred duodenum cannot be used for a Billroth I anastomosis. The Billroth I reconstruction, however, offers the most physiologic anastomosis because it restores normal continuity of the GI tract.
- The Billroth II reconstruction may be complicated by afferent loop syndrome in which obstruction of the afferent limb results in accumulation of bile and pancreatic secretions, causing right upper quadrant abdominal pain that is alleviated by bilious vomiting.
- Roux-en-Y reconstruction allows diversion of bile and pancreatic secretions away from the gastric outlet, thereby reducing the risk of bile reflux gastritis.
- However, it can result in a delay in gastric emptying.
