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

[INTRODUCTION] The efficacy of Billroth II with Braun (BIIB) anastomosis in laparoscopic distal gastrectomy remains uncertain. We aimed to perform a systematic review and meta-analysis comparing BIIB with Roux en Y (RY) for distal laparoscopic gastrectomy.

[METHODS] We systematically searched PubMed, Embase, and Cochrane for studies comparing BIIB versus RY in adult patients undergoing distal gastrectomy. We computed risk ratios (RRs) for binary outcomes and mean differences (MDs) for continuous outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed with I statistics. Statistical analyses were performed using R software, version 4.2.3.

[RESULTS] We included 10 studies, comprising a total of 1377 patients. BIIB was associated with a lower anastomotic time (MD 7.82 min; 95% CI -11.99 to -3.65; p = 0.0002; I = 99%), intraoperative blood loss (MD -17.88 mL; 95% CI -31.00 to -4.76; p = 0.0076; I = 91%), and operative time (MD -21.67 min; 95% CI -28.62 to -14.72; p < 0.01; I = 80%). Also, BIIB group was associated with a higher incidence of bile reflux when compared to the RY group (RR 3.10; 95% CI 1.75 to 5.50; p < 0.0001; I = 74%). There were no significant differences between BIIB and RY for anastomotic leakage rate, number of retrieved lymph nodes, gastritis, residual food, time to first exhaust, length of hospital stay, time to liquid diet, and adverse events.

[CONCLUSION] In adult patients undergoing distal gastrectomy, BIIB was associated with a shorter operative, anastomotic time, and intraoperative blood loss, with an increased incidence of bile reflux. BIIB may be an easier and feasible alternative to RY, especially in patients who should avoid excessive exposure to anesthesia.