Complications of Billroth Surgery

Although most patients will not develop sequelae after surgery, there are unfortunately a large number of early and late postoperative complications that may ensue (Table 3.2).

Leaks

In the early postoperative period after Billroth surgery, anastomotic leaks may develop. Leaks are generally readily detected by water-soluble contrast administration or CT imaging. Subsequent subphrenic abscesses, usually left sided, may ensue. Leaks are the most common cause of mortality after gastric surgery [12].

Rupture of the duodenal stump ("duodenal stump blowout") after Billroth II is one of the most serious complications of gastric surgery. This may occur as early as the first or as late as the nineteenth postoperative day, although it is usually identified between the third to seventh postoperative day [15]. Contrast examination may be diagnostic, although complete filling of the A limb is necessary for diagnosis, and this may be difficult to achieve (Fig. 3.7). CT imaging may reveal extraluminal contrast, collections, and/or abscess adjacent to the duodenal stump or in the right subphrenic space (Fig. 3.8).

Table 3.2. Complications of gastroduodenal surgery.

Early

Duodenal stump blowout Anastomotic leak

Anastomotic edema and gastric outlet obstruction Intussusception (antegrade or retrograde) Gastroileostomy Late

Obstruction secondary to anastomotic stricture

Bezoars (food or yeast)

Intussusception (antegrade or retrograde)

Recurrent (marginal) ulcer

Gastric stump carcinoma

Dumping

Afferent limb syndromes (acute or chronic) Alkaline reflux gastritis Postgastroenterostomy contraction of gastric antrum Efferent loop dysfunction Fistula

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