Effect of semifundoplication with subtotal gastrectomy for prevention of postoperative gastroesophageal reflux.

BACKGROUND: Postgastrectomy patients often experience reflux esophagitis and a compromised quality of life. We hypothesized that reconstructive methods with antireflux procedures at operation should prevent reflux esophagitis and improve the likelihood of a better quality of life in patients after distal gastrectomy for gastric carcinoma. Our antireflux procedure was a subdiaphragmatic semifundoplication. We aim to substantiate, with objective arguments, potential advantages of Billroth I simple reconstruction versus Billroth I with semifundoplication. STUDY DESIGN: This study evaluated 60 patients who had Billroth I reconstruction with semifundoplication (30 patients; F group) and simple Billroth I reconstruction (30 patients; B group) after distal gastrectomy for gastric cancer. Assessments were made preoperatively and 6 months or later after surgical intervention. Results of the procedure, clinical evaluation (reflux symptoms), and esophageal alkaline reflux by ambulatory 24-hour pH memory were satisfactory. RESULTS: Operative evaluation time and procedural complications did not differ significantly between the two gastrectomy groups. Reflux symptoms only occurred in 12 patients in the B group. Lower esophageal sphincter pressure of patients in the B group was significantly lower than that of patients in the F group and in preoperative states (p < 0.05). The mean appearance of alkaline esophageal reflux in the F group and the B group were 2.6% and 13.6%, respectively (p < 0.01). Patients with semifundoplication had a significantly better quality of life and less physiologic regurgitation than patients with simple Billroth I. CONCLUSIONS: This study demonstrated that Billroth I reconstruction with semifundoplication for gastric cancer is not only effective for patients with a postoperative life expectancy, but also prevents reflux esophagitis after gastrectomy. We believe that our method is an effective and simple surgical option for many patients with gastric cancer.