Billroth I and II Operation

Other Known Aliasesgastroduodenostomy and gastrojejunostomy

DefinitionIn a Billroth I procedure, the distal stomach is removed and the distal stomach is connected with a end-to-end anastomosis to the duodenum. In a Billroth II procedure, the distal stomach is removed and connected with a side-to-side anastomosis to the jejunum.

Clinical SignificanceBoth of these procedures are used in distal gastric pathologies, including gastric cancer, recurrent peptic ulcer disease, large duodenal perforations, bleeding gastric ulcer, gastrointestinal stromal tumors, or corrosive stricture of the stomach. A Billroth I is generally preferred as it has less complications and restores normal GI continuity. A Billroth II is used to prevent undue tension on the anastomosis secondary to scarring.

HistoryNamed after Christian Albert Theodor Billroth (1829-1894), who was an Austrian surgeon and generally regarded as the founding father of modern abdominal surgery. He received his medical doctorate from the Frederick William University of Berlin in 1852. His medical career was almost completely abandoned due to his love of music and was a close friend of Johannes Brahms. He became the Chair of Clinical Surgery at the University of Zurich in 1860. He was well known as a charismatic and infectious instructor, attracting students throughout Germany. It was at this post that he published is classic textbook Die allgemeine chirurgische Pathologie und Therapie (General Surgical Pathology and Therapy) in 1863. He was directly responsible for several landmark historical surgeries including:

  • 1872 – first to perform an esophagectomy
  • 1873 – first to perform an laryngectomy
  • 1876 – first to perform rectal cancer excision
  • 1881 – first to perform antrectomy for gastric cancer

Other notable mentions for Dr. Billroth is his early adoption of the “white coat” and surgical cleanliness. He also was an advocate for prolonged surgical apprenticeships following completion of medical studies and was the precursor to William Halsted’s pioneering residency program at Johns Hopkins


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