Roux-en-Y versus Billroth I following distal gastrectomy

The aim of this study was to assess and validate the clinical efficacy of Roux-en-Y reconstruction (R-Y) when compared to Billroth I reconstruction (B-I) after distal gastrectomy (DG).

The authors identified the prospective, randomized, controlled trials comparing R‑Y with B‑I after DG for gastric cancer from January 1990 to July 2016 using PubMed, Web of Knowledge, Ovid’s database. The method of meta-analysis is performed to compare the complications and recurrences of R‑Y versus B‑I.

Seven randomized controlled trials (RCTs) involving 1197 patients were included. Meta-analysis revealed that R‑Y reconstruction was associated with a significant reduction in the incidence of remnant gastritis (Odds ratios [OR] 2.58, 95%Confidence interval [CI]: 1.78, 3.74; P < 0.00001). No significant differences were observed between the groups in terms of intraoperative blood loss (Weighted mean difference [WMD] −20.97, 95%CI: −47.85, 5.92; P = 0.13), time to resumed oral intake (WMD −1.32, 95%CI: −6.39, 3.75; P = 0.61), reflux esophagitis (OR 1.71, 95%CI: 0.82, 3.57; P = 0.15), and recurrence (OR 1.10, 95%CI: 0.44, 2.71; P = 0.84). Moreover, the B‑I reconstruction method took significantly less time to perform as compared to R‑Y reconstruction (WMD −38.12, 95%CI: −50.50, −25.74; P < 0.00001) and postoperative hospital stay was shorter (WMD −2.96, 95%CI: −5.93, 0.00; P = 0.05),

The R‑Y reconstruction was effective in preventing gastritis, although R‑Y reconstruction after gastric resection was inferior to B‑I reconstruction in terms of taking more time to perform and a longer stay in hospital.