Methods of reconstruction–BI, BII, roux–en–Y, jejunal interposition, proximal gastrectomy and pouch reconstruction

Abstract

In this chapter, reconstruction techniques after partial (proximal or distal) and total gastrectomy are discussed. Proximal gastrectomy is most frequently reconstructed with a jejunal interposition. Distal gastrectomy is mainly reconstructed by a Billroth I or II, or a Roux-en-Y operation. Total gastrectomy is reconstructed by a Roux-en-Y or a jejunal or colonic interposition. The formation of a pouch after total gastrectomy is an often performed additional procedure during reconstruction. No evidence-based recommendation which favors reconstruction over proximal resection can be made till date. After distal resection, randomized controlled trials favor a Roux-en-Y reconstruction due to the lower incidence of bilio-pancreatic reflux. After total gastrectomy, randomized controlled trials demonstrated no difference between duodenal-passage-preserving and direct Roux-en-Y reconstructions while better results were achieved in reconstructions including a pouch.