Evidence based recommendations for the reconstruction after distal gastrectomy

E. Strong (ed.). Gastric cancer. Principles and practice. Springer (2015)

As mentioned above, BI reconstruction is only possible in a minority of cases after distal gastrectomy due to the restricted possibilities to mobilize the duodenum and gastric remnant. Two studies comparing BI vs. BII both reported a higher incidence rate of local recurrence after BI, indicating that resection margins and lymph node dissection might have been chosen too limited in order to perform a tension-free anastomosis. As both BI and BII are associated with similar mortality rates as well as symptoms and consequences of bilio-pancreatic reflux, the BI reconstruction is rarely used for malignant diseases in Western countries.

Both the BI and the BII reconstruction have been shown to be inferior in preventing the symptoms and consequences of bilio-pancreatic reflux when compared to RY reconstruction. As the overall survival of patients depends mainly on a radically performed oncological resection, which is in the case of a planned BII or RY not restricted in its dimension, the decision on one of the two reconstruction techniques should be based on the postoperative complication rate and quality of life. As morbidity rates are similar while symptoms resulting from bilio-pancreatic reflux are significantly higher after BII, a RY reconstruction should be favored.

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