Billroth II gastrojejunostomy

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Billroth II gastrojejunostomy is a procedure that has been performed for tumor or severe ulcer disease in the distal stomach.

There are many variations on the procedure, but they generally involve resection of the diseased portion of the distal stomach and a side-to-side anastomosis of the residual stomach to jejunum through the transverse mesocolon. It can be performed with either an antecolic or a retrocolic anastomosis.

There are two portions ("limbs") of the small bowel after the procedure:

  • the limb upstream from the anastomosis (with the duodenum and ampulla of Vater at its origin) has been termed the "afferent limb" (sometimes the "biliopancreatic limb")
  • the limb downstream from the anastomosis (ending at the ileocecal valve), sometimes called the "efferent limb" or "feeding limb"

A Roux-en-Y gastrojejunostomy (as can be seen in Roux-en-Y gastric bypass procedures) has a different configuration than a Billroth II gastrojejunostomy. Some consider the Roux-en-Y a variation of a Billroth II procedure. A Billroth II may be converted into a Roux-en-Y, if necessary.

Treatment and prognosis

Complications
  • dumping syndrome
  • gastrojejunocolic fistula
  • afferent loop syndrome
  • increased risk of gastric adenocarcinoma, 15-20Y post-surgery

History and etymology

It was first performed by T Billroth, an Austrian surgeon, in 1874.