ORIGINAL RESEARCH article
Front. Oncol.
Sec. Surgical Oncology
This article is part of the Research TopicSurgical Management and Outcomes for Gastric CancerView all 10 articles
Comparison of Billroth II and Billroth II with Braun reconstructions after distal gastrectomy for gastric cancer: A meta-analysis
Provisionally accepted
- 1The people's hospital of Chongqing Liang Jiang New Area, Chongqing, China
- 2Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- 3The Second Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
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Background: Billroth II (BII) and BII with Braun (BB) reconstruction represent two comparable techniques employed for reconstruction following distal gastrectomy (DG). Currently, there is uncertainty regarding the superiority of either technique. This meta-analysis aims to assess the safety and efficacy of BII and BB reconstruction following DG for gastric cancer. Methods: Relevant studies comparing BII and BB post-DG for gastric cancer were identified through a comprehensive literature search in PubMed, Embase, Web of Science, and the Cochrane Library, encompassing publications up to the end of June 2025. The primary outcomes assessed included perioperative outcomes, postoperative complications, functional outcomes, and nutritional status. Meta-analyses were performed utilizing RevMan 5.4 software. Results: A total of seven studies encompassing 2,172 patients were included in the meta-analysis. The findings indicated a reduction in operation time (weighted mean difference [WMD], -16.13 minutes; 95% confidence interval [CI], -30.45 to -1.80; P = 0.03) and reconstruction time (WMD, -8.17 minutes; 95% CI, -8.81 to -7.53; P < 0.001). Conversely, an increase was observed in the time to first flatus (WMD, 0.36 days; 95% CI, 0.06 to 0.66; P = 0.02) and the incidence of gastritis grade >2 one year post-surgery (risk ratio, 3.44; 95% CI, 1.82 to 6.47; P < 0.001) in patients undergoing BII reconstruction compared to those receiving BB reconstruction. Conclusion: In comparison to BII reconstruction, BB reconstruction following DG is associated with prolonged operation and reconstruction times but significantly reduces the time to first flatus post-surgery, as well as the incidence of bile reflux and gastritis, despite substantial heterogeneity. Additionally, BB reconstruction may be linked to a lower risk of total postoperative complications and postoperative ileus. Nonetheless, further large-scale studies across diverse populations are necessary, since there is only limited evidence from seven retrospective cohort studies conducted in Asia.
Keywords: Billroth II Braun, Distal gastrectomy, gastric cancer, Meta-analysis, reconstruction
Received: 19 Aug 2025; Accepted: 04 Feb 2026.
Copyright: © 2026 Zhang, Chen, He and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Juan Sun
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