Histological changes in the gastric stump mucosa and late clinical results after Billroth I, Billroth II and Roux-en-Y operations for peptic ulcer disease.

To study the morphological alterations and clinical outcome after gastric resection 53 patients operated on for peptic ulcer disease 5 to 7 years earlier were analyzed. The type of reconstruction was either Billroth I (n = 16), Billroth II (n = 19) or Roux-en-Y (n = 18). Vagotomy was combined with Billroth II in 7 (31%) cases and with Roux-en-Y in 8 (44%) cases. According to a modified Visick classification the late functional results were similar after Billroth reconstructions, whereas failures were most often after Roux-en-Y reconstruction (28%). No ulcer recurrences were found. The histological findings were similar in the operative specimens, but biopsies from the gastric stump mucosa 5 to 7 years after surgery showed significantly (P less than 0.05) more atrophic gastritis after Billroth operations than after Roux-en-Y reconstruction. No dysplastic changes were found. It is concluded that Roux-en-Y reconstruction causes least changes in the gastric stump mucosa after gastric resection. The delayed gastric emptying associated with this procedure may, however, cause late functional disturbances.