A Comparative Study Of Roux-en-Y And Brillroth Ⅱ Anastomosis After Distal Gastrectomy For Gastric Cancer

Aim: Radical resection of the distal gastric carcinoma is a common operative for gastric cancer.There are still different views on the choice of the way of the reconstruction of the digestive tract.This study retrospectively analyzed the Roux-en-Y anastomosis and Billroth-Ⅱ anastomosis concerning perioperative data and early and long-term complications after radical surgery of distal gastric cancer,exploring their advantages and disadvantages,so as to provide a reference for the choice of the way of reconstruction in the future.Methods: According to the inclusion and exclusion criteria,patients underwent radical gastrectomy for gastric cancer from January 2014 to September 2017 in the gastrointestinal center of the Northern Jiangsu People’s Hospital were selected.The clinical data were retrospectively analyzed.Finally,91 cases were included.There were50 cases in Roux-en-y anastomosis group,and 41 cases in Billroth-Ⅱ anastomosis group.The patient’s general information,intraoperative data,pathological data,postoperative recovery,early complications and long-term complications were extracted and analyzed.Results: General data: there was no significant difference between two groups of patients in age,sex,BMI,cardiopulmonary disease,diabetes history,abdominal surgery history,and ASA score(P>0.05).Intraoperative data: There was no significant difference between the two groups in the composition of surgical method;The operative time in the two groups was 160.2±28.6(min),142.1±26(min),and the operation time in the Roux-en-y anastomosis group was longer than Billroth-Ⅱ anastomosis group(P=0.002);The anastomosis time in the two groups was 27.1±4.7(min)and 16.4±3.1(min)respectively and the anastomosis time of the Roux-en-y anastomosis group was longer than that of the Billroth-Ⅱ anastomosis group(P<0.001);The amount ofperioperative bleeding in the two groups was 94.4±60.6(ml),74.6±74.9(ml),and the amount of bleeding in the Roux-en-y anastomosis group was higher than that of the Billroth-Ⅱ anastomosis group,but the difference is not significant(P=0.167).Pathological data: there was no significant difference between the two groups in tumor location,tumor size,lymph node number and lymph node metastasis and pathological stage(P>0.05).Postoperative recovery: There was no significant difference between the two groups in the time of the first extubation,the time of postoperative analgesia,length of postoperative hospital stay and the time of feeding fluid(P>0.05).Early complications: there was no significant difference between the two groups in duodenal stump leakage,delayed gastric emptying,anastomotic stenosis,input loop obstruction,incision infection,anastomotic leakage and postoperative early complications.Long-term complications: There were 3(6%)cases and 10(24.6%)cases with alkaline reflux gastritis in the two groups indicating that Billroth-Ⅱ anastomosis group was significantly more risky in developing alkaline reflux gastritis than Roux-en-y anastomosis group,and the difference was statistically significant(P<0.001);There were 2(4%)cases with reflux esophagitis in Roux-en-y anastomosis group,and 8(19.5%)cases in Billroth-Ⅱ anastomosis group.The incidence of Billroth-Ⅱ anastomosis group was significantly higher than that of Roux-en-y anastomosis group,and the difference was statistically significant(P=0.019);About roux stasis syndrome(RSS),there were 6(12%)cases in Roux-en-y anastomosis group,while 0(0%)cases occurred in Billroth-Ⅱ group.There was significant difference between two groups(P=0.022).There were total 18(36.0%)cases patients with long-term complications in Roux-en-y group,while 39(95.1%)cases patients in Billroth-Ⅱ group,and the incidence of long-term complications in Billroth-Ⅱ anastomosis group was significantly higher than that of Roux-en-y anastomosis group,the difference was statistically significant(P <0.001).There was no significant difference between the two groups in dumping syndrome and intestinal obstruction,which was not statistically significant(P>0.05).Conclusion: The time of Billroth Ⅱ anastomosis and the operation time wereobviously shorter,but there was no significant difference in the amount of bleeding during the operation;There was no significant difference between Roux-en-Y anastomosis and Billroth Ⅱ anastomosis in the time of the first extubation,the time of postoperative analgesia,the length of postoperative hospital stay and the time of feeding fluid;There was no significant difference in early complications between Roux-en-Y anastomosis and Billroth Ⅱ anastomosis;Compared with BillrothⅡanastomosis,the incidence of alkaline reflux gastritis and reflux esophagitis was significantly reduced,the long-term total complication was relatively less,which had significant advantages.However,the incidence of RSS in Roux-en-Y anastomosis was higher;To sum up,Roux en-Y anastomosis and Billroth Ⅱ anastomosis were safe and effective,the appropriate way of anastomosis can be selected according to the specific conditions.