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Background <p>Billroth&#xa0;II (B-II) anastomosis is widely used after distal gastrectomy but is associated with bile reflux and alkaline gastritis. Billroth&#xa0;II with Braun anastomosis (B-B) may reduce these risks, but the evidence is controversial.</p> Methods <p>We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library up to November 2025 for comparative studies (RCTs or cohorts) comparing B‑II vs. B‑B in distal gastrectomy for gastric cancer. Outcomes included perioperative parameters, short-term complications, 1‑year endoscopic findings, and long-term complications. Meta-analysis was performed using random-/fixed-effects models.</p> Results <p>Eight studies (2892 patients; 1366 B‑II, 1526 B‑B) were included. While B‑B had longer operative time (WMD: 22.01; <i>P</i> = 0.003), it was associated with shorter gastric tube removal (WMD: −0.46; <i>P</i> &lt; 0.00001) and earlier flatus (WMD: -0.36; <i>P</i> = 0.02). No significant differences were found in terms of blood loss, hospital stay, overall complications, bleeding, anastomotic leakage, obstruction, pulmonary infection, or bile reflux. However, B‑B significantly reduced grade&#xa0;III–IV gastritis at 1&#xa0;year (RR: 0.29; <i>P</i> = 0.0001). Dumping syndrome and gallstones showed no differences.</p> Conclusion <p>Adding Braun anastomosis to Billroth&#xa0;II facilitates early recovery and reduces moderate-to-severe reflux gastritis without increasing complications. It appears safe and effective as an adjunct, but high-quality RCTs with long-term follow-up are needed to confirm its comprehensive value.</p>

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Comparison of clinical outcomes after Billroth II with and without Braun anastomosis in distal gastrectomy for gastric cancer: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年8月5日

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  • Jia Li Zhang,
  • Xin Yu Zhuang,
  • Zi Wen Li,
  • Xue Fei Yang,
  • Zhong Hui Liu

摘要

Background

Billroth II (B-II) anastomosis is widely used after distal gastrectomy but is associated with bile reflux and alkaline gastritis. Billroth II with Braun anastomosis (B-B) may reduce these risks, but the evidence is controversial.

Methods

We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library up to November 2025 for comparative studies (RCTs or cohorts) comparing B‑II vs. B‑B in distal gastrectomy for gastric cancer. Outcomes included perioperative parameters, short-term complications, 1‑year endoscopic findings, and long-term complications. Meta-analysis was performed using random-/fixed-effects models.

Results

Eight studies (2892 patients; 1366 B‑II, 1526 B‑B) were included. While B‑B had longer operative time (WMD: 22.01; P = 0.003), it was associated with shorter gastric tube removal (WMD: −0.46; P < 0.00001) and earlier flatus (WMD: -0.36; P = 0.02). No significant differences were found in terms of blood loss, hospital stay, overall complications, bleeding, anastomotic leakage, obstruction, pulmonary infection, or bile reflux. However, B‑B significantly reduced grade III–IV gastritis at 1 year (RR: 0.29; P = 0.0001). Dumping syndrome and gallstones showed no differences.

Conclusion

Adding Braun anastomosis to Billroth II facilitates early recovery and reduces moderate-to-severe reflux gastritis without increasing complications. It appears safe and effective as an adjunct, but high-quality RCTs with long-term follow-up are needed to confirm its comprehensive value.