Classiﬁcation of remnant stomach shape after distal gastrectomy
with Billroth-I reconstruction and a comparison of the postoperative
· Tsuyoshi Yamaguchi
· Katsushi Takebayashi
· Satoshi Murata
· Toru Miyake
· Hiroya Iida
· Tomoharu Shimizu
· Masaji Tani
Received: 6 September 2017 / Accepted: 27 April 2018
© Springer Nature Singapore Pte Ltd. 2018
Purpose To classify the shape of the remnant stomach after Billroth-I (B-I) reconstruction and evaluate the relationship
between the shape of the remnant stomach and the postoperative clinical outcomes.
Methods One hundred and ninety-ﬁve consecutive patients with gastric cancer underwent distal gastrectomy with B-I recon-
struction between May 2006 and October 2014. We retrospectively reviewed their medical records and radiological ﬁndings.
Finally, the shapes of the remnant stomach of 150 patients were classiﬁed as either straight type (type A) or stagnant type
(type B). The clinical outcomes were compared with respect to the types of remnant stomach.
Results The incidence of anastomotic leakage was signiﬁcantly higher in the type A group than in the type B group (9.4 vs.
1.5%, p = 0.044). The body weight change ratio after surgery was signiﬁcantly lower in the type B group than in the type
A group [p = 0.0068, two-way repeated measures analysis of variance (ANOVA)], while the serum albumin levels showed
marginally signiﬁcant improvement in the type B group compared with the type A group (p = 0.0542, two-way repeated
Conclusion The shape of the remnant stomach after distal gastrectomy with B-I reconstruction might inﬂuence the degree
of anastomotic leakage and long-term nutritional status.
Keywords Distal gastrectomy · Billroth-I reconstruction · Remnant stomach · Nutritional status
Gastric cancer is currently the fourth most frequent cancer,
and the third leading cause of cancer death worldwide .
Surgical resection with regional lymphadenectomy remains
the most eﬀective treatment for it, and distal gastrectomy
is known to be a safe and common operative procedure for
gastric cancer in the middle and lower stomach .
Several procedures have been developed for reconstruc-
tion after distal gastrectomy, such as the Billroth-I (B-I),
Billroth-II (B-II), and Roux-en-Y (R-Y) methods. B-I is
superior to R-Y in operative simplicity and physiological
passage through the duodenum but inferior to R-Y in
terms of the frequency of postoperative reﬂux symptoms,
esophagitis, and remnant gastritis [3, 4]. Although B-I has
both the advantages and disadvantages described above, it
is also one of the most commonly performed methods after
distal gastrectomy for gastric cancer [5–8], and many reports
have compared the outcomes between the B-I and R-Y meth-
ods [7, 9–11]. However, no reports have described the rela-
tionship between the shape of the remnant stomach after
B-I reconstruction and the postoperative clinical outcomes.
Thus, the purpose of this study was to classify the shape
of the remnant stomach after B-I reconstruction into two
patterns by X-ray ﬂuoroscopy at the front view after admin-
istering the liquid contrast media and to evaluate the rela-
tionship between the shape of the remnant stomach and the
postoperative clinical outcomes (speciﬁcally postoperative
complications and nutritional status) after distal gastrectomy
with B-I reconstruction.
* Sachiko Kaida
Department of Surgery, Shiga University of Medical
Science, Seta Tsukinowa-cho, Otsu-city, Shiga 520-2192,