The effect of the anastomotic size on gastric emptying after hemigastrectomy with Billroth II reconstruction

Objective To determine if the size of the gastrojejunal anastomosis after B illroth II reconstruction was the rate-limiting factor in gastric emptying in the postoperative period. Methods Twelve mongrel dogs were randomized to have either 1.5 cm or 5 cm g astrojejunal anastomoses prior to Billroth II hemigastrectomy, Each dog had three solid and three liquid radiolabelled emptying studies pre- and posto peratively, Data were collected using a gamma camera. For liquid studies, i mages were obtained at 0 min, 2 min, 4 min, 6 min, 8 min, 10 min, 20 min, 3 0 min, 40 min, 50 min and 60 min. For solid studies, images were obtained a t 0 min, 5 min, 10 min, 20 min, 30 min, 40 min, 50 min, 60 min, 70 min, 80 min, 90 min, 100 min, 110 min and 120 min. Means were compared by analysis of variance using the repeated measures option. Results Postoperative liquid emptying was significantly faster in the first 10 min with both 1.5 cm and 5 cm anastomoses compared with preoperative sc ans in the same animals (45% versus 20% and 48% versus 29%, respectively). On the other hand, solid gastric emptying was much slower postoperatively w ith the 1.5 cm anastomosis compared with preoperative scans (29% versus 65% ) as well as compared with postoperative 5 cm anastomosis (29% versus 62%) at the end of 120 min. Conclusions Our model suggests that the gastric emptying of solids is affec ted by the size of the gastrojejunal anastomosis and not by the diameter of the efferent limb of the small intestine following Billroth II reconstruct ion. fur J Gastroenterol Hepatol 11:1359-1364 (C) 1999 Lippincott Williams & Wilkins.