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Billroth II With Braun Anastomosis Versus Roux-En-Y Reconstruction Following Distal Gastrectomy: A Systematic Review

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  • 1Department of Surgery, Gosford Hospital, Gosford, New South Wales, Australia.

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Billroth II with Braun (BIIB) anastomosis in laparoscopic distal gastrectomy offers shorter operative times and less blood loss compared to Roux en Y (RY). However, BIIB is linked to a higher incidence of bile reflux.

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Area of Science:

  • Gastrointestinal Surgery
  • Minimally Invasive Procedures
  • Surgical Anastomosis Techniques

Background:

  • The optimal reconstruction method following laparoscopic distal gastrectomy is debated.
  • Billroth II with Braun (BIIB) anastomosis is a potential alternative to Roux en Y (RY).

Purpose of the Study:

  • To systematically review and meta-analyze the efficacy of BIIB versus RY in laparoscopic distal gastrectomy.
  • To compare key surgical outcomes and complications between BIIB and RY reconstructions.

Main Methods:

  • Systematic literature search of PubMed, Embase, and Cochrane databases.
  • Meta-analysis of 10 studies involving 1377 adult patients.
  • Calculation of risk ratios and mean differences with 95% confidence intervals.

Main Results:

  • BIIB was associated with significantly shorter operative time, anastomotic time, and reduced intraoperative blood loss compared to RY.
  • The BIIB group demonstrated a higher incidence of bile reflux (RR 3.10).
  • No significant differences were observed in anastomotic leakage, lymph node retrieval, or overall adverse events.

Conclusions:

  • Billroth II with Braun anastomosis is a feasible and potentially easier alternative to Roux en Y for laparoscopic distal gastrectomy.
  • BIIB offers advantages in operative efficiency but requires consideration of increased bile reflux risk.
  • This technique may be particularly beneficial for patients needing to minimize anesthesia exposure.