Billroth I and II

Surgical intervention for the treatment of ulcer disorders is sometimes necessary to remove diseased areas and prevent reoccurrence of bleeding and persistent symptoms for non healing ulceration.

Vagotomy is simply cutting of the vagus nerve in an attempt to decrease stimulation of parietal cells and decrease impulses to muscles of the stomach, intestine and gallbladder. Parietel cells are responsible for the secretion of HCL acid and are found in the gastric mucosa.

This procedure may impair gastric emptying and therefore is usually performed along with a Pyloroplasty. Pyloroplasty is enlargement of the pylorus to allow adequate emptying of the stomach. Gastrectomy is removal of the stomach or part of the stomach. The procedures are Billroth I or Billroth II.

Billroth I is removal of the gastric antrum with reanastamosis of the stomach remnant to the proximal duodenum.

Billroth II is removal of the antrum with reanastamosis of the stomach remnant to a loop of the proximal jejunum, food bypasses a large portion of the proximal intestine resulting in suboptimal stimulation of bile and pancreatic secretions.

Afferent Loop: ends proximally at the end of the duodenal bulb closure.

Efferent Loop: the anastamosis of the gastric remnant to the jejunum.

This particular patient has recurrent ulcer despite surgery.