Billroth Concept - What, When, How

What…

The first successful resection of the pylorus followed by anastomosis of the duodenum to the stomach was performed in 1881 by Theodor Billroth.¹ The procedure lasted 1½ hours and was performed on a 43-year-old woman for removal of an “apple sized” carcinoma of the pylorus. Since then, gastric resection and diversion procedures have become some of the most studied surgical procedures to date due to the relatively high incidence of disease in these organs in humans and the complex biochemical and hormonal signaling involved in controlling the function of the upper gastrointestinal tract and biliary system. Improvement in understanding gastric ulcer disease and more targeted medical therapy has reduced the need for these types of procedures in humans, but they are still relatively common. In veterinary surgery, there are very few reports describing the use of Billroth procedures in clinical patients and therefore much of what is known is based on small retrospective case series or individual case reports. In contrast, the dog is used commonly as an experimental model for human application and so there are many reports of various experimental procedures.

When…

Billroth procedures are indicated for gastric outflow obstruction due to various causes including tumors of the pylorus, stomach, pancreas, or biliary system, severe mucosal or muscular hyperplasia of the pylorus, inflammatory polyps, fungal infiltration, or severe ulcerative lesions of the duodenum, pylorus or antrum.2-7 The extent of the lesion will dictate whether a Billroth type I or II procedure is necessary. Similarly, involvement or obstruction of the duodenal papilla or common bile duct will determine whether biliary diversion is also necessary to maintain bile flow. [...]