Billroth-Ⅱ With Braun Versus Roux-en-Y In Laparoscopic Radical Distal Gastrectomy

Objective The purpose of this study is to compare the differences of surgical safety,postoperative recovery and effectiveness of preventing bile reflux between Billroth-Ⅱ with Braun anastomosis and Roux-en-Y anastomosis after laparoscopic radical distal gastrectomy,and to explore the reasonable selection of gastrointestinal reconstruction after radical distal gastrectomy.Method Clinical data of 105 patients with the middle and the lower gastric cancer in our hospital during February 2014 to February 2016 were retrospectively analyzed.All patients underwent laparoscopic-assisted radical distal gastrectomy.49 patients received Billroth-Ⅱ with Braun anastomosis,56 patients received Roux-en-Y anastomosis.Compare the operation time,intraoperative blood loss,postoperative exhaust time,postoperative hospitalization time,postoperative complications,perioperative neutrophil-lymphocyte ratio and the endoscopic results of bile reflux,reflux gastritis at 1 year follow-up between the two groups.Results There was no significant difference in age,sex,BMI,ASA score and TNM staging between the two groups.The operation time of Billroth-Ⅱ with Braun anastomosis was significantly shorter than that of Roux-en-Y anastomosis(P<0.001).There was no significant difference in the blood loss(P >0.05),postoperative exhaust time(P >0.05),postoperative hospital stay(P >0.05)and the hospitalization expenses(P >0.05)between the two groups.There was no significant difference in postoperative complications between the two groups(P >0.05).There was no significant difference in the neutrophil-lymphocyte ratio between the two groups before operation,the first day after operation,the third day after operation and the 7th day after operation(P >0.05).At 12-months postoperatively,endoscopy showed that the incidence rate of bile reflux and reflux gastritis was significantly higher in the Billroth-Ⅱ with Braun anastomosis than in the Roux-en-Y anastomosis(P <0.05).Conclusion Billroth-Ⅱ with Braun anastomosis and Roux-en-Y anastomosis after laparoscopic radical distal gastrectomy have the same safety and efficacy.The operation time of Billroth-Ⅱ with Braun anastomosis is shorter than Roux-en-Y anastomosis.Roux-en-Y anastomosis is better than Billroth-Ⅱ with Braun anastomosis in anti-reflux,reduce the incidence of postoperative bile reflux.The efficiency of Billroth-Ⅱ with Braun anastomosis in anti-reflux still need further study.