Effect of Gastrectomy with Either Roux-en-Y or Billroth II Anastomosis on Small-Intestinal Function

Abstract

This prospective study was undertaken in patients scheduled for gastrectomy for peptic ulcer disease to determine the effect of partial gastrectomy with either Rouxen-Y (n = 11) or Billroth II anastomosis (n = 11) on the function of the small intestine. Patients were studied before and at 6 months (blood and small-intestinal function tests) and at 24 months (blood tests) postoperatively. Median postoperative body weights at 6 months (70.5 kg; p < 0.01) and 12 months (70.3 kg; NS) were lower than preoperatively (73.0 kg). Haemoglobin concentrations at 6 months (8.9 mM; p < 0.01) and at 24 months (9.1 mM; p < 0.05) were also significantly reduced compared with the preoperative value (9.5 mM). However, neither at 6 nor at 24 months postoperatively were there significant changes for serum iron, iron saturation, folic acid, vitamin B₁₂, protein, albumin, alkaline phosphatase, and calcium concentrations. Whereas no significant deterioration of the absorption of d-xylose and vitamin B₁₂ or of faecal fat excretion was observed, the orocoecal transit time was significantly shortened from 98 to 50 min (p < 0.01), the expiratory hydrogen excretion after a 50-g oral glucose load was significantly increased from 8 to 54 ppm (p < 0.01), as was indicanuria from 257 to 368 μmol/24 h (p < 0.01). Apart from a lower serum iron concentration and iron saturation index in the Roux-en-Y patients 6 months postoperatively (p < 0.05), no significant differences between the two types of anastomosis were observed. It is therefore concluded that both in patients with Roux-en-Y and in those with Billroth II anastomosis most abnormalities observed after gastrectomy are secondary to an accelerated small-intestinal transit.

Key Words:

• Absorption
• Billroth II
• breath hydrogen
• indicanuria
• orocoecal transit
• partial gastrectomy
• Roux-en-Y