Partial gastric resection for peptic ulcer--comparison of the effect of variant reconstructive procedures on gastric emptying, gastric acid secretion and gastrin release in the early postoperative period II. Billroth-I gastroduodenostomy and comparison versus gastroenteroanastomotic procedures.

Gastric emptying (GE) of a radiolabelled solid meal, gastric acid secretion and gastrin release was measured before and/or by 91/2 weeks postoperatively in 12 patients with partial gastric resection supplied with Billroth-I gastroduodenoanastomosis and usually (n = 10) with truncal vagotomy [B-1+(VT))]. The results obtained were compared to those derived from another study involving 14 patients with partial gastric resection supplied with a gastroenterostomy (of Roux-en-Y type in 11, and Billroth-II type in 3 subjects) and truncal vagotomy [Roux(B-II)+VT]. The B-I+(VT) procedure affected significantly neither the overall GE (the median T1/2 was 75 min before and 95 min after the surgery) nor the GE pattern-the median curve shape parameter S was 0.73 before and 1.07 after the operation. The basal and pentagastrin-stimulated gastric acid secretion was reduced by an average of 79% (from 8.6 +/- 2.5 to 1.8 +/- 0.5 mmol h-1, p < 0.05) and 77% (from 22.0 +/- 2.8 to 5.0 +/- 1.5 mmol h-1, p < 0.05) after the B-I+(VT), respectively. Moreover, after the B-I+(VT) a decrease in the fasted serum gastric concentration (78.3 +/- 17.0 before vs 62.4 +/- 6.9 ng l-1 after the surgery) and in the postprandial gastrin release (AUC0-120: 11716 +/- 2482 ng l-1 min before vs 9753 +/- 1183 ng l-1 min after the surgery) was found; the relevant differences were, however, statistically not significant. In patients with a preoperatively normal GE, a markedly slowed GE (T1/2 above the limit of the mean T1/2 +2SD in healthy controls) was found in 5 out of 8 (62%) patients after the Roux-en-Y procedure, and only in 1 out of 7 (14%) patients after the B-I or B-II procedure. With regard to the postoperative data, the Roux (B-II)+VT resulted in lower gastric acid secretion and gastrin release than the B-I+(VT) procedure but the relevant differences were statistically not significant.