FATHER SATURNINO URIOS UNIVERSITY

San Francisco St. Butuan City 8600, Region XIII

Caraga, Philippines Nu sin Progra

RESOURCE MANUAL

Billroth 1 and Billroth 2

Content:

I. Introduction

Definition and Significance:

Billroth I and II procedures are surgical techniques used in gastric surgery. They are named after
the German surgeon Theodor Billroth and are fundamental in the treatment of various gastric
disorders, including peptic ulcers and gastric cancer. These are two popular methods to perform
Antrectomy, the removal of the distal third of the stomach (The gastric or pyloric antrum.) with
an anastomosis (surgical connection).
II. Billroth I Procedure

Gastroduodenostomy/ Billroth I - Removal of the lower portion of the antrum of the stomach ,
(Contains G-cells that secrete gastrin) and the portions of duodenum and pylorus.
A. Indications

Billroth I procedure, also known as gastroduodenostomy, is indicated in cases where the distal
portion of the stomach needs to be removed, commonly due to complications from peptic ulcers
or gastric cancer. B. Surgical Steps Pre-operative:

- Ensure informed consent is signed and done.

- Conduct a thorough assessment of health history, current health status, coexisting
conditions.
- Prepare compatible blood bags as needed.
- Administer intravenous fluids and antibiotics as ordered.
Intraoperative:

· Incision and Exploration:

A midline or upper midline incision is made in the abdomen to access the stomach.

The abdominal cavity is explored to assess the extent of the disease and the overall condition of
the abdominal organs.

· Gastrectomy:

The diseased portion of the stomach is removed, typically involving the lower part of the
stomach.

· Reconstruction:

The cut end of the remaining stomach (proximal) is directly attached to the duodenum.

The connection can be created using various techniques, such as hand-sewn or stapled
anastomosis.

· Closure:

The abdominal layers are closed carefully, ensuring minimal risk of postoperative hernias and
infections.
Postoperative Care

- Patients are put on a liquid diet initially and then transition to soft foods.
- Close monitoring for complications such as leakage at the anastomosis site or infection.
- Complications include dumping syndrome (rapid gastric emptying), hemorrhage and
postoperative bleeding from the surgical site, and bile reflux.
- Gastric outlet obstruction
III. Billroth II Procedure

Gastrojejunostomy/ Billroth II- Removal of the antrum of the stomach with anastomosis to
jejunum. A duodenal stump remains oversewn.

A. Indications

Billroth II procedure, or gastrojejunostomy, is performed when a larger portion of the stomach

needs to be removed, often due to advanced gastric cancer or extensive peptic ulceration. Billroth
II can also be performed to bypass large portions of the small intestine for weight-loss as well.

B. Surgical Steps Pre-operative:

- Ensure informed consent is signed and done.

- Conduct a thorough assessment of health history, current health status, coexisting
conditions.
 - Prepare compatible blood bags as needed.
- Administer intravenous fluids and antibiotics as ordered.
Intraoperative:

· Incision and Exploration:

Similar abdominal incision as in Billroth I.

Thorough exploration for metastases or other abnormalities.

· Gastrectomy:

Removal of a larger portion of the stomach, leaving a small gastric pouch.

· Reconstruction:

Creation of a gastrojejunostomy involves attaching the remaining stomach to the jejunum.

Optionally, a jejunojejunostomy may be created for better food transit.

· Closure:

Standard closure of abdominal layers is performed.

Postoperative Care:

- Patients are on a strict postoperative diet, starting with clear fluids and gradually
progressing to soft foods.
- Careful monitoring for complications, including dumping syndrome and malabsorption
issues.

IV. Nursing Responsibilities & Considerations

1. Monitor vital signs accurately

2. Monitor the operative site and determine any signs of infection
3. Monitor for potential complications including bowel obstruction, anastomotic leak, and
post-operative bleeding.
4. Administer prescribed pain medications as ordered (NSAIDS are usually avoided)
5. Educate patient to avoid aspirin, foods and beverages that contains caffeine
 6. Instruct patient to report any signs or occurrence of dumping syndrome which is
characterized by abdominal pain and discomfort, lightheadedness, sweating, diarrhea,
vomiting.
7. Place the patient in low fowler’s or supine position after each meal.
8. Advise to consume, or provide small frequent, high protein meals and snacks.
9. Advise or instruct patient to avoid consuming liquids with meals, as well as simple
carbohydrates (Sweets, and sweetened drinks)
V. Conclusion

In conclusion, Billroth I and II procedures remain vital techniques in gastrointestinal surgery,

addressing a range of gastric disorders. Understanding these procedures is essential for medical
professionals involved in the treatment of gastric conditions, ensuring effective patient care
especially for potential complications and improved outcomes.

VI. Questions and Discussion

Open the floor for questions and discussions from classmates, encouraging an interactive session
to deepen understanding and clarify any doubts.

QUIZ FOR BILLROTH 1 AND BILLROTH 2

Question 1: What is the alternative name for the Billroth I procedure?

A) Gastrojejunostomy
B) Gastroduodenostomy
C) Duodenogastrostomy
D) Gastrocolostomy

Answer: B) Gastroduodenostomy

Question 2: In which condition is the Billroth I procedure commonly indicated?

A) Gallstones
B) Appendicitis
C) Peptic ulcers or gastric cancer
D) Pancreatitis
Answer: C) Peptic ulcers or gastric cancer

Question 3: What does the Billroth II procedure involve?

A) Connecting the stomach directly to the colon

B) Connecting the stomach directly to the jejunum
C) Removing the entire stomach
D) Bypassing the stomach entirely

Answer: B) Connecting the stomach directly to the jejunum

Question 4: Which of the following is a potential complication after both Billroth I and II
procedures?

A) Bladder infection

B) Respiratory distress

C) Anastomotic leakage

D) Vision problems

Answer: C) Anastomotic leakage

Question 5: What is the primary purpose of creating an anastomosis in both Billroth I and
II procedures?

A) To improve patient's vision

B) To connect the remaining stomach to the colon

C) To restore the continuity of the digestive system

D) To create an artificial stomach

Answer: C) To restore the continuity of the digestive system

Question 6: Which of the following statements about the Billroth II procedure is correct?

A) It involves connecting the stomach directly to the duodenum.

B) It leaves a larger portion of the stomach intact compared to Billroth I.

C) It is also known as gastrocolostomy.

D) It bypasses the entire small intestine.

Answer: B) It leaves a larger portion of the stomach intact compared to Billroth I.

7. What is dumping syndrome, a potential complication of both Billroth I and II

procedures?

A) Rapid emptying of the stomach causing discomfort and diarrhea.

B) Accumulation of gas in the stomach leading to bloating.
C) Slow digestion of food causing constipation.
D) Formation of ulcers in the stomach lining.

Answer: A) Rapid emptying of the stomach causing discomfort and diarrhea

8. Which part of the digestive system is directly connected to the remaining stomach in
both Billroth I and II procedures?

A) Duodenum
B) Jejunum
C) Ileum
D) Colon
Answer: A) Duodenum

9. What is the term for the technique used to attach the remaining stomach to the
duodenum or jejunum in Billroth I and II procedures?

A) Anastomosis
B) Incision
C) Suturing
D) Excision

Answer: A) Anastomosis

10. What is the alternative name for Billroth II procedure?

A) Gastrojejunostomy
B) Duodenocolostomy
C) Jejunogastrostomy
D) Gastroileostomy

Answer: A) Gastrojejunostomy

References:

Hinkle, J. L., Cheever, K. H., & Overbaugh, K. J. (2022). Brunner & Suddarth's textbook of
medical-surgical nursing. 15th edition. Philadelphia, Wolters Kluwer Health.

Marsh, A. M., & Lopez, J. L. (2023). Gastric Resection. In StatPearls. StatPearls Publishing
Available from: https://www.ncbi.nlm.nih.gov/books/NBK560760/

Sigmon, D. F., & Lopez, P. P. (2023). Gastrojejunostomy. In StatPearls. StatPearls Publishing.

Available from: https://www.ncbi.nlm.nih.gov/books/NBK560493/