Different Features of Complications with Billroth-I and Roux-en-Y Reconstruction After Laparoscopy-Assisted Distal Gastrectomy

Background: This study investigated differences in the features of postoperative complications between Billroth-I (B-I) and Roux-en-Y (R-Y) reconstructions after laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer. Material and methods: The study included 424 patients who underwent LADG for cT1, cN0 gastric cancer. Patient characteristics, surgical outcomes, postoperative complications including severity assessment using the Clavien-Dindo classification, and risk factors related to postoperative complications were analyzed. Results: B-I and R-Y were performed in 329 and 95 patients, respectively. Total time in hospital was longer in R-Y (15. 2 ± 10. 5 days) than in B-I (12. 8 ± 6. 4 days; P = 0. 034). The incidence of severe complications was higher in R-Y (13. 7%) than in B-I (5. 2%; P = 0. 009). Three cases of internal hernia and three cases of duodenal stump leakage were observed in R-Y. Univariate analysis revealed the method of reconstruction was a risk factor for severe postoperative complications after LADG (P = 0. 006). Conclusions: The features of postoperative complications are quite different between B-I and R-Y after LADG. Complications after R-Y were more severe than those after B-I. To avoid these severe complications in R-Y, it is necessary to understand these different features.