RT Book, Section A1 Ellison, E. Christopher A1 Zollinger, Robert M. SR Print(0) ID 1127272084 T1 HEMIGASTRECTOMY, BILLROTH II STAPLED T2 Zollinger's Atlas of Surgical Operations, 10e YR 2016 FD 2016 PB McGraw-Hill Education PP New York, NY SN 978-0-07-179755-9 LK accesssurgery.mhmedical.com/content.aspx?aid=1127272084 RD 2024/03/29 AB The Billroth II gastric resection is one of the most commonly performed procedures for malignancy of the stomach or for the control of gastric hypersecretion in the treatment of ulcer. The extent of the resection varies, with a two-thirds to three-fourths resection being the most common. When the left gastric vessels are ligated, 75% or more of the stomach is resected with the major blood supply coming from the gastrosplenic circulation. In the presence of carcinoma involving the body of the stomach, all the lymph nodes along the lesser curvature up to the esophagus are resected. The greater omentum is also removed, along with any lymph nodes about the right gastroepiploic vessels. When a malignancy is near the pylorus, 2 to 3 cm at least of the duodenum distal to the pylorus should be resected (see discussion in Chapter 26). Sometimes only a rim of gastric mucosa remains attached to the esophagus, which may require reconstruction with sutures rather than with the stapler. Consideration should be made for laparoscopic resection in cases without a contraindication such as extensive previous operations or large bulky tumors.