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.