1. Primary distal gastrectomy continues to be indicated, primarily, in patients with a gastric tumor or a suspicion of tumor. However, there is a huge population of patients that have had gastric surgery for peptic ulcer disease and present with post gastrectomy syndromes.
2. The primary reconstructions following distal gastrectomy are gastroduodenostomy (Billroth I), loop gastrojejunostomy (Billroth II), and end gastrojejunostomy (Roux-en-Y). After near total gastrectomy a reservoir can be created using a Roux gastroje-junostomy and may provide long-term benefits especially for patients requiring gastrectomy for tumors.
3. Unfortunately, all reconstructions following partial gastrectomy are associated with a high risk of long-term complications. The most common postgastrectomy syndromes are dumping, alkaline reflux gastritis, and gastric stasis.
4. The Billroth I reconstruction has the lowest incidence of postgastrectomy syndromes and is the reconstruction of choice if it can be done safely.
5. A Billroth II should be done if a Billroth I cannot be performed safely. The Roux-en-Y reconstruction is usually not done primarily after distal gastrectomy, but should be reserved for certain types of revisional gastric surgery and if subtotal gastrectomy is necessary.
6. Most patients with postgastrectomy syndromes can be can be stabilized on dietary or medical therapy. When postgastrectomy symptoms are severe, revisional gastric surgery is generally beneficial.
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