Four reconstruction methods after laparoscopic distal gastrectomy: A systematic review and network meta-analysis

Abstract

Background: There is no consensus regarding which reconstruction methods are superior after laparoscopic distal gastrectomy (LDG). This study compared four reconstruction methods after LDG for gastric cancer.

Methods: Literature in EMBASE, PubMed, and the Cochrane Library was screened to compare Billroth I (B-I), Billroth II (B-II), Roux-en-Y (RY), and uncut Roux-en-Y (URY) anastomoses after LDG for gastric cancer. A Bayesian network meta-analysis (NMA) was conducted to compare these methods.

Results: Eighteen studies involving 4347 patients were eligible for our NMA. The operative time in RY anastomosis was longer than that in B-I and B-II anastomoses. Blood loss and risk of gastrointestinal motility dysfunction were greater with RY anastomosis than with URY or B-I anastomosis. Furthermore, URY anastomosis was superior to the other 3 reconstruction methods for preventing food residue. For remnant gastritis, RY anastomosis was significantly superior to B-I and B-II anastomoses, whereas URY anastomosis was significantly superior to B-II anastomosis. In addition, RY and URY anastomoses were better than B-I and B-II anastomoses for preventing bile reflux.

Conclusions: URY anastomosis tended to be a more favorable reconstruction method after LDG due to its operative simplicity and reduced long-term complications.

Figure 1

Flow diagram for the identification of eligible studies. RCT = randomized controlled trial.

Figure 2

Network graph of the included studies. B-I = Billroth I anastomosis, B-II = Billroth II anastomosis, RY = Roux-en-Y anastomosis, URY = uncut Roux-en-Y anastomosis.

Figure 3

Results of network and direct comparisons between different reconstructions. B-I = Billroth I anastomosis, B-II = Billroth II anastomosis, OR = odds ratio, RY = Roux-en-Y anastomosis, SMD = standardized mean difference, URY = uncut Roux-en-Y anastomosis. The columns represent direct comparisons, and the rows represent all network comparisons.