Randomized controlled trial of uncut Roux-en-Y vs Billroth II reconstruction after distal gastrectomy for gastric cancer: Which technique is better for avoiding biliary reflux and gastritis?

Figure 1 Two kinds of reconstruction after laparoscopy-assisted distal gastrectomy. A: Uncut Roux-en-Y reconstruction; B: Billroth II reconstruction. All included patients underwent LADG with D2 lymphadenectomy, which was performed by the same surgical team. Then, two groups underwent different reconstructions as shown.

Figure 2 Bile reflux grades. During the endoscopic examination, a modified biliary reflux classification in three grades was applied. A: grade 0, absence of bile (Figure 2A); B: grade 1, small amount of bile located in the bottom of residual stomach without overflow (Figure 2B); C: grade 2, bile spilled into the jejunum with tidal rhythm (Figure 2C).

Figure 3 Biopsy for gastritis. Gastric tissue biopsies were taken to compare the degree of gastritis: A: grade 0 [hematoxylin and eosin (HE) staining, × 200], normal mucosa with small amount of lymphocytes and transparent microscopic field; B: grade 1 (HE, × 200), intermediate between grades 0 and 2 with a moderate amount of lymphocytes or other kinds of inflammatory cells; C: grade 2 (HE, × 400), acute inflammation with fully infiltrated tissue by lymphocytes or other kinds of inflammatory cells.

Figure 4 Perioperative potential of hydrogen (pH) in the stomach of the patients. Change of potential of hydrogen (pH) in the remnant stomach was recorded at 8:00 am on the day before surgery as well as 1-5 d after surgery. During the postoperative period, all stomach pH values of group U patients were below 7.00. Conversely, all stomach pH values of group B patients were higher than 7.00.