Does the addition of Braun anastomosis to Billroth II reconstruction on laparoscopic-assisted distal gastrectomy benefit patients?

Xiong-Guang Li; Qi-Ying Song; Di Wu; Shuo Li; Ben-Long Zhang; Li-Yu Zhang; Da Guan; Xin-Xin Wang; Lu Liu

doi:10.4251/wjgo.v14.i6.1141

Does the addition of Braun anastomosis to Billroth II reconstruction on laparoscopic-assisted distal gastrectomy benefit patients?

World J Gastrointest Oncol. 2022 Jun 15;14(6):1141-1147. doi: 10.4251/wjgo.v14.i6.1141.

Authors

Xiong-Guang Li¹, Qi-Ying Song¹, Di Wu¹, Shuo Li¹, Ben-Long Zhang¹, Li-Yu Zhang¹, Da Guan¹, Xin-Xin Wang², Lu Liu¹

Affiliations

¹ Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China.
² Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China. 301wxx@sina.com.

Abstract

Background: Operation is the primary therapeutic option for patients with distal gastrectomy. Braun anastomosis is usually performed after Billroth II reconstruction, which is wildly applied on distal gastrectomy because it is believed to benefit patients. However, studies are needed to confirm that.

Aim: To identify whether the addition of Braun anastomosis to Billroth II reconstruction on laparoscopy-assisted distal gastrectomy benefits patients.

Methods: A total of 143 patients with gastric cancer underwent laparoscopy-assisted distal gastrectomy at Centre 1 of PLA general hospital between January 2015 and December 2019. Clinical data of the patients were collected, and 93 of the 143 patients were followed up. These 93 patients were divided into two groups: Group 1 (Billroth II reconstruction, 33 patients); and Group 2 (Billroth II reconstruction combined with Braun anastomosis, 60 patients). Postoperative complication follow-up data and relevant clinical data were compared between the two groups.

Results: There were no significant differences between Group 1 and Group 2 in postoperative complications (6.1% vs 6.7%, P = 0.679), anal exhaust time or blood loss. The follow-up prevalence of reflux gastritis indicated no significant difference between Group 1 and Group 2 (68.2% vs 51.7%, P = 0.109). The follow-up European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 scores revealed no evident difference between Group 1 and Group 2 as well. Group 1 had a shorter operating time than Group 2 on average (234.6 min vs 262.0 min, P = 0.017).

Conclusion: Combined with Billroth II reconstruction, Braun anastomosis has been applied due to its ability to reduce the prevalence of reflux gastritis. Whereas in this study, the prevalence of reflux gastritis showed no significant difference, leading to a conclusion that under the circumstance of Braun anastomosis costing more time and more money, simple Billroth II reconstruction should be widely applied.

Keywords: Bile reflux; Billroth II reconstruction; Braun anastomosis; Gastric cancer.