Answer c -

In Billroth II surgery, afferent limb obstruction is more common

In Billroth I reconstruction The remnant is anastomosed  to the duodenum

In Billroth II duodenum stump is closed and stomach is anastomosed to the jejunum limb

Advantages of Billroth I

• More Physiological as normal GI continuity is maintained
• No problem of afferent and efferent limb
• Future procedures like endoscopy and ERCP can be done
• Reduced chance of gastric carcinoma in remnant stomach as compared to Billroth 2  ( SKF page 682) 

In surgery for benign gastric ulcers, Billroth I reconstruction is the preferred choice.

Billroth II surgery has problems of

• Retained antrum syndrome
• Afferent loop obstruction
• Duodenal stump leak (1-3%

Billroth 2 surgery is done when there is

1. Inadequate mobility of the duodenum

2. Scarring of duodenum

Complications of gastric surgery
Complications of gastrectomy

• Nutritional and weight loss - Iron deficiency, Copper deficiency, Vit B12 , Anemia
• Delayed gastric emptying
• Roux statsis- Seen in roux en y loops-  Pain, nausea, vomiting, abdominal bloating
• Cholelithiasis-  Higher incidence in roux en y reconstruction as compared to B1 and B 2 gastrectomy
• Recurrent ulceration

Complications of Billroth 2 surgery

• Dumping syndrome Dumping symptoms have been reported in up to 70% of Billroth II patients and up to 75% of patients after RYGBP for obesity.
• Afferent loop obstruction - It can be minimized by keeping the length of afferent loop less than 20 cm and using a retrocloic approach.
• Bile reflux gastritis - More common with billroth I and billroth 2 surgery, incidence is decreasing after the use roux en y anastomosis