Effects of laparoscopic distal gastrectomy with Roux-en-Y anastomosis on postoperative gastrointestinal symptom recovery and bile reflux incidence in patients with gastric cancer.

BACKGROUND

The optimal reconstruction method after laparoscopic distal gastrectomy (LDG) for gastric cancer is debated. This study compared Billroth-II (BII) and Roux-en-Y (RY) anastomoses in terms of postoperative recovery, bile reflux, and quality of life.

METHODS

This retrospective cohort study enrolled patients with gastric cancer undergoing LDG from June 2022 to June 2024. These patients were stratified into the LDG-BII and LDG-RY groups. Data collected included perioperative outcomes, gastric pH measured preoperatively and on postoperative days 1-3, gastrointestinal symptoms assessed employing the Patient Assessment of Gastrointestinal Symptoms (PAGI-SYM) questionnaire at six months postoperation, endoscopic findings evaluated by using the Ruggeri-Giustini-Balestra classification at six months postoperation, complications, and nutritional and quality of life assessments obtained with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Stomach Module at six months postoperation.

RESULTS

The analysis included 257 patients (LDG-BII: 126; LDG-RY: 131). Compared with the LDG-BII group, the LDG-RY group had longer anastomosis times (30.24 min vs. 28.89 min, P < 0.001) but earlier first flatus (P = 0.003) and shorter hospital stay (11.28 vs. 12.17 days, P = 0.027). The LDG-BII group had significantly higher gastric pH on postoperative day 1 (6.91 vs. 6.58, P < 0.001), worse six-month reflux symptoms (PAGI-SYM score: 14.15 vs. 12.71, P < 0.001), and higher rates of substantial endoscopic bile reflux (grade 2: 17.46% vs. 6.11%, P < 0.001) than the LDG-RY group. Quality of life related to reflux was worse in the LDG-BII group (gastric cancer-specific quality of life questionnaire score: 3.57 vs. 3.12, P < 0.001) than in the LDG-RY group.

CONCLUSION

Compared with BII, RY reconstruction after LDG reduces bile reflux and improves key patient-reported and endoscopic outcomes despite having a longer operative time.