Billroth I Vs. Billroth II Vs. Roux-en-Y Following Distal Gastrectomy: a Meta-analysis Based on 15 Studies

Background/aims: After a distal resection of the stomach, the continuity of the gastrointestinal tract can be restored by either a gastroduodenal anastomosis (Billroth I), a gastrojejunal anastomosis (Billroth II) or a Roux-en-Y gastrojejunostomy. There is still no consensus on the reconstruction technique of choice. The aim of this report was to assess the value of Roux-en-Y (RY) gastrojejunostomy as a gastric substitute after distal gastrectomy, compared with Billroth I (BI) gastroduodenal anastomosis or Billroth II (BII) gastrojejunal anastomosis.

Methodology: A systematic literature search was carried out and a meta-analysis was executed according to the QUOROM statement. Only randomized controlled trials (RCTs) comparing reconstruction techniques among BI, BII and RY were eligible for inclusion. Data on total postoperative complications, local anastomotic leakage, mortality, local recurrence, reflux symptoms, dumping syndrome, reflux esophagitis, reflux gastritis, operation time, intraoperative bleeding and hospital stay were extracted from the RCTs for meta-analysis using fixed-effects models for the calculation of pooled estimates of treatment effects.

Results: Fifteen RCTs comparing reconstruction techniques among BI, BII and RY were included. The results of the meta-analyses show that RY reconstruction does not significantly increase postoperative complications. Patients with RY reconstruction complained significantly less of reflux symptoms and had significantly reduced reflux gastritis and esophagitis. Quality of life was significantly improved in patients with RY reconstruction compared with patients with BI or BII reconstruction.

Conclusions: This meta-analysis highlights some clinical advantages of RY reconstruction after distal gastrectomy.