Related Experiment Video
Updated: Jan 8, 2026
Robotic D3 Partial Duodenal Resection with Primary Side-to-Side Anastomosis
Published on: December 15, 2023
Reconstruction after distal gastrectomy and alkaline gastritis: a multi-center three-arm randomized trial comparing
Hoseok Seo1, Sang-Yong Son2, Hoon Hur2
1Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Background:
The optimal reconstruction method following distal gastrectomy is crucial for improving postoperative outcomes and quality of life (QOL) in gastric cancer survivors. This study aims to compare three reconstruction methods-uncut Roux-en-Y (R-Y) with Billroth-II (B-II) and B-II Braun-in terms of bile reflux, other endoscopic findings, and QOL.
Methods:
The study was a multi-center, open-label, phase 3 randomized controlled trial conducted across four hospitals. A total of 189 patients were enrolled and randomly assigned to the B-II, B-II Braun, or uncut R-Y groups in a 1:1:1 ratio. The primary endpoint was the incidence of bile reflux at 3 months postoperatively, evaluated via endoscopic examination. Secondary endpoints included additional endoscopic findings and QOL assessments using questionnaires survey.
Results:
The operation time was significantly longer in the uncut R-Y group compared to the other groups. There were no significant differences in short-term outcomes among the three groups. The incidence of bile reflux at 3 months was significantly lower in the uncut R-Y group (6.8%) compared to the B-II (77.6%) and B-II Braun (63.6%) groups (p < 0.001). This superiority was sustained at 12 months (10.5% vs. 86.0% vs. 67.9%, respectively; p < 0.001). The uncut R-Y group also exhibited relatively lower rates of alkaline reflux gastritis and epigastric soreness. Dietary intake increased in all three groups from 3 to 12 months postoperatively, with no significant differences between the groups.
Conclusions:
Uncut R-Y is superior to B-II and B-II Braun in reducing bile reflux and related symptoms after distal gastrectomy. These findings support the adoption of uncut R-Y as a preferred reconstruction method for long-term QOL improvement in gastric cancer patients.
Registration Number:
KCTXXXXX (https://cris.nih.go.kr).
