Analysis of Clinical Efficacy and Quality of Life of Braun Anastomosis in Gastrointestinal Reconstruction in Totally Laparoscopic Distal Gastrectomy: A Single-center Retrospective Study

Abstract

Abstract Objective This study aimed to compare the clinical efficacy and quality of life of B-IIB( Billroth-II with Braun anastomosis) and B-II (Billroth-II anastomosis) in the alimentary tract reconstruction postoperative totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. Methods From February 2016 to January 2022, 158 patients underwent totally laparoscopic distal gastrectomy and D2 lymphadenectomy in Northern Jiangsu People’s Hospital, with Billroth-II with Braun anastomosis for 93 patients and Billroth-II anastomosis for 65 patients. The patients’s data were collected prospectivly and reviewed retrospectively. Results In this study, the post-op hospital stay for B-IIB group were shorter than for B-II group (12.70 ± 3.08 days in the B-IIB group versus 14.12 ± 4.90 days in the B-II group, p < 0.05) and the first post-op anal wind time for the B-IIB group were shorter than for B-II group (3.49 ± 1.02 days versus 4.08 ± 1.85 days, p < 0.05). Two groups did differ significantly in hemoglobin on postoperative 3 months, albumin at 3 months after operation and serum sodium on postoperative 3 days and 3 months (p < 0.05), and the B-IIB had an advantage; the incidence of complications of Clavien-Dindo grade II or higher in the B-IIB group and B-II were 10.75% and 29.23%, respectively. There being a statistical difference between the two groups. The B-IIB group and the B-II group both had different degrees of weight loss at 3 months after operation compared with preoperative weight. The weight of Billroth-II combined with Braun reconstruction group was 4.04 ± 1.33 kg, which was less than 8.08 ± 1.47kg of Billroth-II reconstruction group.The difference was statistically significant (p < 0.05). According to the PGSAS ( Postgastrectomy Syndrome Assessment Scale), the score of the Billroth-II with Braun reconstruction group is lower than that of the Billroth-II reconstruction group for esophageal reflux gastritis, dyspepsia and dumping syndrome group (1.84 ± 0.92 VS 2.15 ± 0.85, P = 0.031; 1.86 ± 1.10 VS 2.22 ± 0.91, P = 0.034; 1.98 ± 1.06 VS 2.32 ± 0.94, P = 0.037, respectively). Conclusion Totally laparoscopic distal gastrectomy with Billroth-II Braun reconstruction is a safe and technically feasible method for gastric cancer patients, which can reduce the incidence of postoperative reflux esophagitis and dumping syndrome. Compared with Billroth-II reconstruction,it has advantages in maintaining postoperative nutritional status and electrolyte balance and improving quality of life.