Partial gastrectomy and reconstruction

Distal (partial) gastrectomy is performed by removing the distal portion of the stomach (A, shaded region between line 2 and line 4). Gastrointestinal continuity can be restored using one of three techniques. The first (B), known as a Billroth I reconstruction, anastomoses the stomach to the duodenal remnant. The Billroth II reconstruction (C) brings up a loop of proximal jejunum to create an end-to-side gastrojejunostomy. Another option is a Roux-en-Y gastrojejunostomy (D), in which the more distal jejunum is anastomosed to the stomach in an end-to-side fashion.