Partial Gastrectomy with Billroth I Reconstruction

Abstract

Indications • Gastric ulcer • Prepyloric ulcer • Recurrent ulcer of the stomach and duodenum (after vagotomy) • Early gastric or antral carcinoma or other gastric malignancies (see Chap. 10) Essential Steps 1. Upper midline incision. 2. Confirm pathology. 3. Identify probable points of division of the stomach on the greater and lesser curvature. 4. Create an opening in the gastrocolic omen-tum close to the gastric wall near the point of division. 5. Create a similar window in lesser omentum. 6. Serially clamp, divide, and ligate branches of the gastroepiploic vessels with 2-0 silk, progressing toward the duodenum. 7. Similarly divide lesser omentum, taking care to identify and protect the common bile duct. 8. Perform a Kocher maneuver. 9. Circumferentially dissect the duodenum, taking care to protect the common bile duct, gastroduodenal artery, and pancreas. 10. Place bowel clamps across the duodenum and divide it. 11. Divide the stomach with 90-mm linear stapler and remove the specimen. 12. Amputate the greater curvature tip of the gastric remnant. 13. Approximate the duodenum to gastric remnant. 14. Construct a two-layer anastomosis. 15. Check hemostasis. 16. Close the abdomen. Note These Variations • Stapled anastomosis is also possible. • Early division of the stomach facilitates difficult duodenal dissection. • Biopsy gastric ulcer (if not previously done) to exclude malignancy. Complications • Anastomotic leak • Recurrent ulcer • Injury to the common bile duct or pancreas R.R. Danks, DO