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THE INFLUENCE OF RECONSTRUCTION METHOD ON DIGESTIVE AND ABSORPTIVE DYNAMICS AFTER DISTAL GASTRECTOMY
Koji Nakada*2, Masahiko Kawamura2, Hideo Konishi2, Taizo Iwasaki2, Keishiro Murakami2, Atsuo Shida2, Fumiaki Yano2, Nobuyoshi n. Hanyu2, Norio Mitsumori2, Akihiro Ohnishi1, Katsuhiko Yanaga2
1Laboratory Medicine, The Jikei University School of Medicine, Tokyo, Japan; 2Surgery, The Jikei University School of Medicine, Tokyo, Japan
BACKGROUND: Both Billroth-I (DGBI) and Roux-en-Y methods (DGRY) are common reconstruction procedures after distal gastrectomy. Since the duodenal passage of ingested food is retained, DGBI is called “physiological reconstruction” and is presumed to have better digestive and absorptive function as compared to DGRY. However, the effect of these reconstruction procedures on digestive and absorptive function has not been fully investigated.
AIM: To study the effect of reconstruction procedures on fat digestive and absorptive dynamics after distal gastrectomy.
METHODS: 13C-octanoin (13C-OA) breath test to assess absorptive function, and 13C-trioctanoin (13C-TO) breath test to assess fat digestive and absorptive function were undertaken in 36 patients who underwent distal gastrectomy (Distal gastrectomy with DGBI; n=20, Distal gastrectomy with DGRY; n=16) more than a year earlier. Liquid meal (Racol [200 kcal/200 ml; Otsuka Pharm.Co. Ltd, Tokyo, Japan] + fresh cream 35 ml [fat content 47%]; total fat 20 g) mixed with 100 mg of 13C-octanoin (OA) or 13C-trioctanoin (TO) was given separately. Breath samples were collected before and at 5, 10, 15, 20, 30, 40, 50, 60, 75, 90, 105, 120, 135, 150, 165, 180, 210, 240, 270 and 300 minutes after ingestion of the test meal. 13CO2 content was measured by infrared spectro-photometry. The following parameters were used to compare digestive and absorptive functions between DGBI and DGRY; Absorptive functions: OA-Aa, half absorptive time: OA-T50%, fat digestive and absorptive functions: TO-Aa, half-fat digestive and absorptive time: TO-T50% and half-fat digestive time: [TO-T50%] - [OA-T50%].
RESULTS: The parameters for digestive and absorptive functions in DGBI and DGRY were (1) OA-Aa: 20.5% dose and 19.5% dose, (2) TO-Aa: 13.2% dose, 13.8% dose and (3) [TO-T50%] - [OA-T50%]: 41.1 min and 58.4 min*, respectively (*p<0.05). In summary, there were no statistical differences both in absorptive function, and fat digestive and absorptive function between DGBI and DGRY. However, half-fat digestive time of DGRY was significantly prolonged as compared to that of DGBI.
CONCLUSIONS: The reconstruction procedures after distal gastrectomy have an effect on fat digestive and absorptive dynamics, and that the postprandial pancreaticobiliary asynchrony may, in part, explain delayed fat digestive and absorptive speed in DGRY.
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