| Objective:With the mature development of surgical treatment for malignant tumors in the gastric body and antrum,there are various options for digestive tract reconstruction after distal radical gastrectomy(DRG)for distal gastric cancer(DGC),including Billroth Ⅰ,Billroth Ⅱ(B-Ⅱ),Billroth Ⅱ combined with Braun anastomosis(B-Ⅱ-B),and Roux-en-Y.All of them are effective reconstruction methods,but there is still controversy over which one is the best.In recent years,laparoscopic techniques have made great progress,providing minimally invasive and low invasive options for abdominal surgery patients.In order to explore the advantages and disadvantages of different digestive tract reconstruction methods after total laparoscopic distal radical gastrectomy for DGC patients,this study aims to investigate the short-term clinical efficacy and quality of life of two different anastomosis methods(B-Ⅱand B-Ⅱ-B),in order to further clarify the role of Braun anastomosis(B)and its advantages in DRG.The target journal is the International Journal of Surgery.Methods:This study included 158 patients who underwent laparoscopic DRG in a hospital from February 2016 to January 2022.Relevant clinical data of the patients were collected and they were divided into two groups according to the different anastomosis methods used:BillrothⅡ(B-Ⅱ)group and Billroth Ⅱ combined with Braun anastomosis(B-Ⅱ-B)group.General information,perioperative data,postoperative pathological data,and nutritional status analysis data(including weight changes,hemoglobin,albumin,and electrolyte concentrations 3 months after surgery)were compared between the two groups,as well as postoperative complications(Clavien-Dindo grade Ⅱ and above),and subjective patient evaluations such as reflux esophagitis(RE),gastrointestinal adverse reactions,and dumping syndrome were assessed using the Post-gastrectomy Comprehensive Symptom Assessment Scale questionnaire-45(PGSAS-45).Statistical analysis was performed using SPSS 25.0 software,and a P-value less than 0.05 was considered statistically significant.The target journal is the International Journal of Surgery.Results:1.Comparison of general information between the two groups of patients:There was no statistically significant difference in age,gender,weight,BMI(Body mass index,BMI),and other factors between the two groups of patients(P>0.05).2.Comparison of perioperative indicators:The average length of hospital stay and the time to first anal exhaust in the B-Ⅱ-B group were 12.70±3.08d and 3.50±1.02d,respectively,which were significantly shorter than those in the B-Ⅱ group(14.12±4.91d and 4.08±1.85d,P<0.05).However,there was no statistically significant difference in the duration of surgery,intraoperative blood loss,time to first defecation after surgery,and time to first oral intake between the two groups(P>0.05).3.Comparison of postoperative pathological data:There was no statistically significant difference in TNM staging,tumor diameter,number of lymph node dissections,and number of positive lymph nodes between the two groups(P>0.05).4.Nutritional status analysis:At the third month after surgery,the average values of hemoglobin(HGB),albumin(ALB),and serum sodium concentration in the B-Ⅱ-B group were 126.97±24.02g/l,39.14±5.68g/l,and 141.03±5.87mmol/L,respectively,which were significantly higher than those in the B-Ⅱ group(118.57±19.82g/l,36.63±4.71g/l,and 138.71±5.65mmol/L,P=0.0220,P=0.003,and P=0.014,respectively).The serum sodium concentration in the B-Ⅱ-B group was significantly higher than that in the B-Ⅱ group at the third day after surgery(P<0.05).The weight loss in the B-Ⅱ-B and B-Ⅱ groups at the third month after surgery was 4.043±1.326kg and 8.077±1.472kg,respectively,with a statistically significant difference between the two groups(P<0.05).5.According to the occurrence rate of Clavien-Dindo grade Ⅱ or above complications,the B-Ⅱ-B group(2.1%)was significantly lower than the B-Ⅱ group(10.7%,P=0.003),especially in the incidence of postoperative intestinal obstruction,which was significantly lower in the B-Ⅱ-B group than in the B-Ⅱ group(P<0.05).6.According to the PGSAS-45 evaluation questionnaire,the B-Ⅱ-B group scored lower in the symptoms of gastroesophageal reflux,dumping syndrome,and indigestion,indicating its advantages in improving the postoperative quality of life of patients.Conclusion:After laparoscopic distal radical gastrectomy,Billroth Ⅱ+Braun anastomosis has comparable surgical safety to the Billroth Ⅱ group for patients with distal gastric cancer.The B-Ⅱ-B group has advantages in improving patients’ postoperative nutritional status,electrolyte balance,and quality of life,especially in preventing dumping syndrome and gastroesophageal reflux.The B-Ⅱ-B group also has a certain effect in preventing postoperative complications,especially postoperative intestinal obstruction,further improving the postoperative quality of life for B-Ⅱ-B patients.Therefore,laparoscopic B-Ⅱ-B is a viable option for digestive tract reconstruction after DRG. |
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