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

Abstract

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.

Keywords: Anastomosis; Conventional Billroth II; Gastric cancer; Laparoscopy; Meta-analysis; Uncut Roux-en-Y.

Figure 1

Study flow diagram. URY: Uncut Roux-en-Y; BB: BII combined Braun; CNKI: Chinese National Knowledge Infrastructure; CBD: Chinese Biomedical Database.

Figure 2

Results of meta-analysis. A: Operative time; B: Reconstruction time; C: Intraoperative blood loss; D: Total number of harvested lymph nodes. URY: Uncut Roux-en-Y; BB: BII combined Braun; CI: Confidence interval.

Figure 3

Results of meta-analysis of postoperative recovery. A: Time to first passage of flatus or defecation; B: Time to first solid diet; C: Mean gastric pH at day 1; D: Mean gastric pH at day 3; E: Postoperative hospitalization time. URY: Uncut Roux-en-Y; BB: BII combined Braun; CI: Confidence interval.

Figure 4

Results of meta-analysis. A: Anastomotic leakage; B: Ileus; C: Reflux gastritis; D: Gastroparesis. URY: Uncut Roux-en-Y; BB: BII combined Braun; CI: Confidence interval.

Figure 5

Anastomosis method. A: Uncut Roux-en-Y; B: Billroth II with Braun.