Transcript apc-general surgeons use the billroth ii

RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE
MINI-GASTRIC BYPASS
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Introduction
Since its inception by Billroth the loop gastrojejunostomy (Billroth II) has been in continuous use to
this day for over a hundred years by general, trauma
and oncologic surgeons around the world.
Some BARIATRIC surgeons have criticized the MGB
for the use of the Billroth II gastro-jejunostomy.
The hypothesis of this paper is that, while some
BARIATRIC surgeons fear the Billroth II, general,
trauma and oncologic surgeons routinely use the
Billroth II.
For example in recent years, laparoscopic
gastrectomy for gastric cancer is developing rapidly.
The surgeon’s choice for digestive tract reconstruction
routinely includes Billroth I, Billroth II and Roux-en-Y
anastomoses after laparoscopic distal gastrectomy.
Methods
Literature review of the frequency, use and
publications on Billroth II by general and oncologic
surgeons. The US National Hospital Discharge Database
was reviewed for the frequency and use of the BII..
Results
WARNING: A BII reconstruction is NEVER appropriate
as a gastric reconstruction after total or subtotal
gastrectomy!
This has caused some confusion because of the failed
use of a BII loop in the FAILED Old Mason Loop Gastric
Bypass.
To Restate:
BII is a standard and routine technique to reconstruct
the stomach following distal gastrectomy (Mini Bypass)
BUT
BII is NEVER Appropriate after Total or Subtotal
Gastrectomy (Old Mason Loop Bypass)
Example Recent publication of BII after distal
gastrectomy for Cancer from
J Lee et al J Korean Surg Soc. 2012 March; 82(3): 135–142.
Results
In hopes of educating readers on the use of Billroth II
please note the following:
In 2007 16,234 Billroth II gastro-jejunostomies were
performed for trauma, ulcer disease and cancer in the
USA.
From 1947 through 2012 the BII was routinely reported
as used by both general and oncologic surgeons as a
means of reconstructing the stomach following distal
gastrectomy including 1563 articles in Pubmed (19472012)
Recently 41 articles by gastric cancer surgeons
describe selection of the BII as the method of choice
for routine gastric reconstruction in the treatment of
gastric cancer following dital gastric Resection.
In a study by Porie 50% of Gastro-Js were BII’s
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Conclusions
The Billroth II is not a perfect surgery. But has been
and remains a foundational part of every general,
trauma and oncologic surgeons operative
armamentarium.
I can be and has bee used inappropriately in some
cases (Old Mason Loop Bypass) and this predictably
can lead to poor results.
On the other hand appropriate use of the BII is a
regular routine and valuable part of the general
surgery tool set and has excellent short and long term
results (Mini-Gastric Bypass)