Roux-en-Y and Billroth II Reconstruction After Pancreaticoduodenectomy: A Meta-Analysis of Complications

Objective: To evaluate Roux-en-Y and Billroth II reconstruction following pancreaticoduodenectomy (PD).

Methods: PubMed, Embase, the Cochrane Library, and the Web of Science were searched to identify randomized controlled trials (RCTs) and controlled clinical trials that compared Roux-en-Y and Billroth II reconstruction following PD up to December 2019. RevMan 5.3 software was used for the statistical analysis.

Results: Four RCTs and five controlled clinical trials were included, with a total of 1,072 patients (500 and 572 patients in the Roux-en-Y and Billroth II groups, respectively). No significant differences in delayed gastric emptying (DGE), A-grade DGE, B-grade DGE, or C-grade DGE were observed between the Roux-en-Y and Billroth II reconstruction groups after PD (odds ratio [OR] = 1.01, 95% confidence interval [CI]: 0.50-2.03, = 0.98; OR = 0.49, 95% CI: 0.17-1.45, = 0.20; OR = 0.63, 95% CI: 0.29-1.38, = 0.25; and OR = 2.13, 95% CI: 0.38-11.99, = 0.39). No significant difference in the incidence of postoperative pancreatic fistula, abscess, bile leaks, infection, postoperative bleeding, or the length of the postoperative hospital stay was observed between the Roux-en-Y and Billroth II groups ( > 0.05), but the operation time was significantly different (mean difference [MD] = 31.65, 95% CI: 7.14-56.17, = 0.01).

Conclusions: Billroth II reconstruction after PD did not significantly reduce the incidence of DGE or other complications but shortened the operation time compared to Roux-en-Y reconstruction. However, the results must be verified by further high-quality, large RCTs or controlled clinical trials.