Features of the complications for intracorporeal Billroth-I and Roux-en-Y reconstruction after laparoscopic distal gastrectomy for gastric cancer

Early Outcomes of Different Reconstruction Procedures in Radical Distal Gastrectomy: A Retrospective Propensity Score Matching Study

OBJECTIVE

To evaluate the short-term effects of Billroth I (B-I), Billroth Ⅱ (B-Ⅱ), Billroth Ⅱ+Braun (B-B), and Roux-en-Y (R-Y) reconstruction procedures in radical distal gastrectomy using propensity score matching (PSM).

MATERIALS AND METHODS

The clinical data of 1994 patients who underwent radical distal gastrectomy in the past 10 years were retrospectively analyzed. Subsequently, PSM analyses were performed 3 times on the 4 reconstruction procedures, and the matching capacity was set to 0.01. Data regarding control variables and outcome indicators obtained using PSM were compared and analyzed.

RESULTS

Compared with the other reconstruction procedures, patients in the B-I group had shorter operation time ( P =0.002), fewer abdominal drainage tubes ( P <0.001), and a lower risk of postoperative gastroparesis ( P =0.001) and gastrointestinal bleeding ( P =0.034), but tended to experience a longer postoperative indwelling time of bladder catheter ( P <0.001), gastrointestinal decompression ( P <0.001), fasting ( P =0.001), and hospital stays ( P =0.005). The B-B group tended to have fewer applications of the abdominal drainage tube ( P =0.014), a lower risk of postoperative gastrointestinal fistula ( P =0.040), shorter postoperative time of gastrointestinal decompression ( P =0.043), fasting ( P <0.001), and a shorter hospital stay ( P <0.001) than the R-Y group. Furthermore, the B-B group had a shorter postoperative time for gastrointestinal decompression ( P =0.014) and fasting ( P <0.001) than the B-Ⅱ group.

CONCLUSION

Billroth I reconstruction has the advantages of simple operation, short operative time, and few early complications, but tends to result in a long recovery time during postoperative hospitalization. The B-B operation is associated with faster postoperative recovery than the R-Y or B-Ⅱ operation.

Comparison between laparoscopic uncut Roux-en-Y and Billroth II with Braun anastomosis after distal gastrectomy: A meta-analysis

BACKGROUND

Conventional Billroth II (BII) anastomosis after laparoscopic distal gastrectomy (LDG) for gastric cancer (GC) is associated with bile reflux gastritis, and Roux-en-Y anastomosis is associated with Roux-Y stasis syndrome (RSS). The uncut Roux-en-Y (URY) gastrojejunostomy reduces these complications by blocking the entry of bile and pancreatic juice into the residual stomach and preserving the impulse originating from the duodenum, while BII with Braun (BB) anastomosis reduces the postoperative biliary reflux without RSS. Therefore, the purpose of this study was to compare the efficacy and safety of laparoscopic URY with BB anastomosis in patients with GC who underwent radical distal gastrectomy.

AIM

To evaluate the value of URY in patients with GC.

METHODS

PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Database, and VIP Database for Chinese Technical Periodicals (VIP) were used to search relevant studies published from January 1994 to August 18, 2021. The following databases were also used in our search: Clinicaltrials.gov, Data Archiving and Networked Services, the World Health Organization International Clinical Trials Registry Platform Search Portal (https://www.who.int/clinical-trials-registry-platform/the-ictrp-search-portal), the reference lists of articles and relevant conference proceedings in August 2021. In addition, we conducted a relevant search by Reference Citation Analysis (RCA) (https://www.referencecitationanalysis.com). We cited high-quality references using its results analysis functionality. The methodological quality of the eligible randomized clinical trials (RCTs) was evaluated using the Cochrane Risk of Bias Tool, and the non-RCTs were evaluated using the Newcastle-Ottawa scale. Statistical analyses were performed using Review Manager (Version 5.4).

RESULTS

Eight studies involving 704 patients were included in this meta-analysis. The incidence of reflux gastritis [odds ratio = 0.07, 95% confidence interval (CI): 0.03-0.19, P < 0.00001] was significantly lower in the URY group than in the BB group. The pH of the postoperative gastric fluid was lower in the URY group than in the BB group at 1 d [mean difference (MD) = -2.03, 95%CI: (-2.73)-(-1.32), P < 0.00001] and 3 d [MD = -2.03, 95%CI: (-2.57)-(-2.03), P < 0.00001] after the operation. However, no significant difference in all the intraoperative outcomes was found between the two groups.

CONCLUSION

This work suggests that URY is superior to BB in gastrointestinal reconstruction after LDG when considering postoperative outcomes.

A Modified Billroth-II with Braun Anastomosis in Totally Laparoscopic Distal Gastrectomy: Initial Experience Compared with Roux-en-Y Anastomosis

BACKGROUND

This retrospective study aimed to compare the feasibility and effectiveness of a modified Billroth-II with Braun (B-II Braun) reconstruction and those of a Roux-en-Y (R-Y) reconstruction after laparoscopic distal gastrectomy.

METHODS

From January 2016 to December 2019, 247 patients underwent total laparoscopic distal gastrectomy (TLDG), with B-II Braun reconstruction for 145 patients and R-Y reconstruction for 102 patients. The patients' data were collected prospectively and reviewed retrospectively.

RESULTS

In this study, the median times of the operation were statistically shorter for B-II Braun than for R-Y (167 min [range, 110-331 min] vs 191 min [range, 123-384 min]; p = 0.001), including anastomotic times (33 min [range, 30-42 min] vs 42 min [range, 40-48 min]; p = 0.001). After a short-term follow-up period, endoscopy showed 31 cases of bile reflux (21.4%), 15 cases of grade 2 gastritis (10.3%), and 6 cases of grade 2 food residue (4.1%) in the B-II Braun group after 6 months. After 1 year, 10 patients (6.9%) had grade 2 gastritis and 2 patients (1.4%) had grade 3 gastritis. However, the remnant stomach of the two groups did not differ significantly in the rate of gastric residue (p = 0.112 after 6 months; p = 0.579 after 1 year, respectively), gastritis (p = 0.726 after 6 months; p = 0.261 after 1 year, respectively), or bile reflux (p = 0.262 after 6 months; p = 0.349 after 1 year, respectively).

CONCLUSIONS

For gastric cancer patients, TLDG with modified B-II Braun reconstruction could be technically feasible. It has an acceptable range of postoperative complications and is effective in preventing bile reflux into the gastric remnant.