Early Outcomes of Different Reconstruction Procedures in Radical Distal Gastrectomy: A Retrospective Propensity Score Matching Study.

OBJECTIVE: To evaluate the short-term effects of Billroth I (B-I), Billroth Ⅱ (B-Ⅱ), Billroth Ⅱ+Braun (B-B), and Roux-en-Y (R-Y) reconstruction procedures in radical distal gastrectomy using propensity score matching (PSM).

MATERIALS AND METHODS: The clinical data of 1994 patients who underwent radical distal gastrectomy in the past 10 years were retrospectively analyzed. Subsequently, PSM analyses were performed 3 times on the 4 reconstruction procedures, and the matching capacity was set to 0.01. Data regarding control variables and outcome indicators obtained using PSM were compared and analyzed.

RESULTS: Compared with the other reconstruction procedures, patients in the B-I group had shorter operation time (P=0.002), fewer abdominal drainage tubes (P<0.001), and a lower risk of postoperative gastroparesis (P=0.001) and gastrointestinal bleeding (P=0.034), but tended to experience a longer postoperative indwelling time of bladder catheter (P<0.001), gastrointestinal decompression (P<0.001), fasting (P=0.001), and hospital stays (P=0.005). The B-B group tended to have fewer applications of the abdominal drainage tube (P=0.014), a lower risk of postoperative gastrointestinal fistula (P=0.040), shorter postoperative time of gastrointestinal decompression (P=0.043), fasting (P<0.001), and a shorter hospital stay (P<0.001) than the R-Y group. Furthermore, the B-B group had a shorter postoperative time for gastrointestinal decompression (P=0.014) and fasting (P<0.001) than the B-Ⅱ group.

CONCLUSION: Billroth I reconstruction has the advantages of simple operation, short operative time, and few early complications, but tends to result in a long recovery time during postoperative hospitalization. The B-B operation is associated with faster postoperative recovery than the R-Y or B-Ⅱ operation.