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The aim of the study was to compare the clinical symptoms between Billroth II (B-II) and Roux-en-Y (R-Y) reconstruction after distal subtotal gastrectomy (DG) for gastric cancer.Surgery is the mainstay of curative treatment for gastric cancer. The technique for reconstruction after DG remains controversial. Both B-II and R-Y are popular methods.This is a prospective multicenter randomized controlled trial. From October 2008 to October 2014, 162 patients who underwent DG were randomly allocated to B-II (n = 81) and R-Y (n = 81) groups. The primary endpoint is Gastrointestinal (GI) Symptoms Score 1 year after surgery. We also compared the nutritional status, extent of gastritis on endoscopy, and quality of life after surgery between the 2 procedures at 1 year.Operative time was significantly shorter for B-II than for R-Y [mean difference 21.5 minutes, 95% confidence interval (95% CI) 3.8-39.3, P = 0.019]. The B-II and R-Y groups had a peri-operative morbidity of 28.4% and 33.8%, respectively (P = 0.500) and a 30-day mortality of 2.5% and 1.2%, respectively (P = 0.500). GI symptoms score did not differ between R-Y versus B-II reconstruction (mean difference -0.45, 95% CI -1.21 to 0.31, P = 0.232). R-Y resulted in a lower median endoscopic grade for gastritis versus B-II (mean difference -1.32, 95% CI -1.67 to -0.98, P0.001). We noted no difference in nutritional status (R-Y versus B-II mean difference -0.31, 95% CI -3.27 to 2.65, P = 0.837) and quality of life at 1 year between the 2 groups too.Although BII is associated with a higher incidence of heartburn symptom and higher median endoscopic grade for gastritis, BII and RY are similar in terms of overall GI symptom score and nutritional status at 1 year after distal gastrectomy.

The long-term results of omental patch repair for perforated duodenal ulcer are unsatisfactory; a high incidence of ulcer recurrence has been repeatedly reported. 1–4 Some advocate immediate acid-reduction procedures in addition to repair of the ulcer as a preventive measure against subsequent ulcer relapse. 5,6 Immediate definitive surgery in selected patients is safe, without increasing the rate of perioperative complications or death. 7 However, with recent advances in antiulcer medical therapy, fewer surgeons have acquired sufficient expertise in performing the definitive operation. Moreover, because perforated peptic ulcer isoften an “out of hours” emergency, a simpler life-saving procedure such as omental patch repair is an attractive option in many centers. The recent rediscovery of Helicobacter pylori has revolutionized the therapeutic approach to peptic ulcer disease. Eradication of H. pylori heals most uncomplicated peptic ulcers and prevents relapse. 8–10 In the case of bleeding peptic ulcers, a short course of antibiotics eradicating H. pylori is as efficacious as maintenance acid-reduction medication in preventing recurrent ulcer hemorrhage. 11 Both the National Institute of Health Consensus Meeting and the Maastricht Meeting of the European Helicobacter pylori Study Group have recommended eradication of H. pylori as the standard treatment for uncomplicated and bleeding peptic ulcers. 12,13 However, the association between H. pylori and perforated duodenal ulcer is less well defined. The reported infection rates range widely, from 47% by serologic testing 14 to more than 80% in two recent biopsy-based studies. 15,16 Whether there is a causal relation between the bacterium and duodenal ulcer perforation is controversial. We therefore performed a prospective randomized trial to determine whether eradication of H. pylori could lead to sustained ulcer remission in patients who underwent only simple repair for duodenal ulcer perforation.