Delta-shaped Anastomosis Versus Billroth I Anastomosis In Laparoscopic Radical Resection Of Distal Gastric Cancer:A Meta-analysis On Short-term Efficacy

Objective:the aim of this study is System evaluation of totally laparoscopic delta-shaped anastomosis(TLDA)on the effectiveness and safety of laparoscopic gastric cancer radical.Method:Using the method of combining subject headings and keywords retrieval words in English to gastric cancer,totally laparoscopic distal gastrectomy,laparoscopic assisted distal gastrectomy,Billroth Ⅰ gastrointestinal anastomosis,Delta-shaped anastomosis,and so on,Chinese word retrieval in stomach,laparoscopic assisted,delta-shaped anastomosis as keywords retrieval respectively Pub med,Web of Science,EMBASE,MEDLINE,WanFang database,Chinese biomedical literature database and other database in both English and Chinese(built library retrieval time to June 2016).And back to find relevant literature references,and in strict accordance with the inclusion criteria and exclusion criteria to eliminate related literature.Using Cochrance registries RevMan5.2.3 statistical software for Meta analysis.Result:totally laparoscopic Delta-shaped anastomosis(TLDA)and laparoscopic assisted Bilroth-I anastomosis(LABIA)comparison results.Operation evaluation indexes: the meta-analysis were included in the 15 study,a total of 3088 patients,including TLDA group(total laparoscopic triangle anastomosis)1270 cases,LABIA group(laparoscopic assisted finish-I anastomosis)in 1818 cases.The meta-analysis results show: comparing with the LABIA group,group TLDA in less intraoperative blood loss(MD=-25.71,95%CI:-33.51~-17.92,P < 0.05);Intraoperative lymph node cleaning more(SMD=2.44,95%CI:0.30~4.57,P=0.03),the two groups in operative time,distance of proximal cut end,distal cut edge distance,difference has no statistical significance(P > 0.05).Postoperative recovery index: this meta-analysis results show: comparing with the LABIA group,group TLDA shorter hospitalization time(SMD=-0.41,95%CI:-0.80~--0.02,P=0.04),postoperative the first time of flatus shorten(SMD=-0.46,95%CI:-0.76~-0.16,P=0.02)fewer postoperative analgesic drug use(SMD=-0.90,95%CI:-1.67~-0.13,P=0.02),for the first time through the mouth eating time difference between two groups has no statistical significance(P > 0.05).Postoperative complications: the Meta analysis results show two groups of operation in always related complications and anastomotic complication(anastomotic bleeding,anastomotic leakage,anastomotic stenosis)difference between what is happening with no statistical significance(P > 0.05).Conclusion:All patients with laparoscopic delta-shaped anastomosis can reduce intraoperative blood loss,increase the number of lymph node cleaning,promote patients recovery,shorter hospitalization time,time of first flatus is short,less analgesic use frequency),and does not affect patients total complications and postoperative anastomotic related complications.