Comparison of quality of life between Billroth-І and Roux-en-Y anastomosis after distal gastrectomy for gastric cancer: A randomized controlled trial

Abstract

Studies comparing Billroth-I (B-I) with Roux-en-Y (R-Y) anastomosis are still lacking and inconsistent. The aim of this trial was to compare the quality of life (QoL) of B-I with R-Y reconstruction after curative distal gastrectomy for gastric cancer. A total of 140 patients were randomly assigned to the B-I group (N = 70) and R-Y group (N = 70) with the comparable baseline characteristics. The overall postoperative morbidity rates were 18.6% and 25.7% in the B-I group and R-Y group without significant difference. More estimated blood loss and longer surgical duration were found in the R-Y group. At the postoperative 1 year time point, the B-I group had a higher score in pain, but lower score in global health. However, the R-Y anastomosis was associated with lower incidence of reflux symptoms at postoperative 6 months (P = 0.002) and postoperative 9 months (P = 0.007). The multivariable analyses of variance did not show any interactions between the time trend and grouping. For the results of endoscopic examination, the degree and extent of remnant gastritis were milder significantly in the R-Y group. The stronger anti-reflux capability of R-Y anastomosis contributes to the higher QoL by reducing the reflux related gastritis and pain symptoms, and promotes a better global health.

Laparoscopic Hiatal Hernia Repair and Roux-en-Y Conversion for Refractory Duodenogastroesophageal Reflux after Billroth I Distal Gastrectomy

“…Multiple methods are available to reconstruct the gastrointestinal tract after distal gastrectomy. Typical reconstruction techniques include Billroth I, Billroth II, and Roux-en-Y [ 1 2 ]. Each reconstruction method has its own advantages and disadvantages [ 2 ].…”

“…Typical reconstruction techniques include Billroth I, Billroth II, and Roux-en-Y [ 1 2 ]. Each reconstruction method has its own advantages and disadvantages [ 2 ]. Although Billroth I has advantages such as shorter operation time and fewer surgical complications than Roux-en-Y, it also has a major disadvantage of causing reflux symptoms [ 2 8 9 ].…”

“…Each reconstruction method has its own advantages and disadvantages [ 2 ]. Although Billroth I has advantages such as shorter operation time and fewer surgical complications than Roux-en-Y, it also has a major disadvantage of causing reflux symptoms [ 2 8 9 ]. The stronger anti-reflux capability of Roux-en-Y anastomosis has been demonstrated to contribute to a higher patient quality of life by reducing reflux-related gastritis and esophagitis [ 2 3 9 ].…”

“…After distal gastrectomy for gastric cancer, reconstruction of the gastrointestinal tract is necessary. There are various methods of reconstruction, such as Billroth I, Billroth II, and Roux-en-Y [ 1 2 3 ]. Billroth I or II anastomosis is the most commonly performed procedure because it is simpler than Roux-en-Y anastomosis [ 4 ].…”

“…However, reflux of duodenal contents into the gastric remnant and esophagus, termed as duodenogastroesophageal reflux (DGER), can occur in patients who have undergone Billroth I or II reconstruction. This can cause serious complications and decrease the quality of life of these patients [ 2 ].…”