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Background <p>The optimal reconstruction method following pancreaticoduodenectomy or distal gastrectomy remains unclear. Although both Roux-en-Y and Billroth II techniques are widely employed, comparative evidence regarding delayed gastric emptying and postoperative outcomes remains conflicting. This systematic review and meta-analysis aimed to provide definitive evidence comparing these reconstructive approaches using high-quality randomized controlled trials.</p> Methods <p>A comprehensive systematic review was conducted following the PRISMA guidelines and registered in PROSPERO (CRD420251121574). We searched PubMed/MEDLINE, Embase, Cochrane CENTRAL, and Web of Science from inception through 5th August, 2025 for randomized controlled trials comparing Roux-en-Y and Billroth II reconstruction following pancreaticoduodenectomy or distal gastrectomy. The primary outcomes were delayed gastric emptying and overall postoperative complications. Secondary outcomes included mortality, anastomotic leakage, operative time, blood loss, and length of hospital stay. Risk ratios and mean differences with 95% confidence intervals were calculated using random-effects models. Evidence certainty was assessed using the GRADE methodology.</p> Results <p>Six randomized controlled trials encompassing 698 patients (345 Roux-en-Y, 353 Billroth II) were included. No significant difference was observed in delayed gastric emptying between groups (OR 0.90, 95% CI 0.48–1.67, <i>p</i> = 0.73). Roux-en-Y reconstruction was associated with significantly fewer overall postoperative complications (OR 0.54, 95% CI 0.37–0.79, <i>p</i> = 0.001) and shorter hospital stay (MD − 0.92&#xa0;days, 95% CI − 1.67 to − 0.18, <i>p</i> = 0.02). No significant differences were found in mortality, anastomotic leak, bile leak, pancreatic fistula, operative time, blood loss, time to first flatus, or time to oral intake. Subgroup analysis revealed geographic variations in delayed gastric emptying outcomes.</p> Conclusion <p>Roux-en-Y reconstruction offers superior postoperative morbidity outcomes and shorter hospital stays compared to Billroth II, without increasing delayed gastric emptying or other complications. These findings support Roux-en-Y as the preferred reconstruction when Billroth I is not feasible.</p>

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Roux-en-Y Versus Billroth II Reconstruction Following Pancreaticoduodenectomy or Distal Gastrectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Evaluating Delayed Gastric Emptying and Postoperative Outcomes

  • 期刊论文

  • 发表日期：

    2025年10月14日

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  • Wajahat Mirza,
  • Farwa Khan,
  • Mehak Ejaz Khan,
  • Hadi Mohammad Khan,
  • Sundus Dadan,
  • Maaz Bin Badshah,
  • Abdul Rafeh Awan,
  • Muhammad Ahmad Nadeem

摘要

Background

The optimal reconstruction method following pancreaticoduodenectomy or distal gastrectomy remains unclear. Although both Roux-en-Y and Billroth II techniques are widely employed, comparative evidence regarding delayed gastric emptying and postoperative outcomes remains conflicting. This systematic review and meta-analysis aimed to provide definitive evidence comparing these reconstructive approaches using high-quality randomized controlled trials.

Methods

A comprehensive systematic review was conducted following the PRISMA guidelines and registered in PROSPERO (CRD420251121574). We searched PubMed/MEDLINE, Embase, Cochrane CENTRAL, and Web of Science from inception through 5th August, 2025 for randomized controlled trials comparing Roux-en-Y and Billroth II reconstruction following pancreaticoduodenectomy or distal gastrectomy. The primary outcomes were delayed gastric emptying and overall postoperative complications. Secondary outcomes included mortality, anastomotic leakage, operative time, blood loss, and length of hospital stay. Risk ratios and mean differences with 95% confidence intervals were calculated using random-effects models. Evidence certainty was assessed using the GRADE methodology.

Results

Six randomized controlled trials encompassing 698 patients (345 Roux-en-Y, 353 Billroth II) were included. No significant difference was observed in delayed gastric emptying between groups (OR 0.90, 95% CI 0.48–1.67, p = 0.73). Roux-en-Y reconstruction was associated with significantly fewer overall postoperative complications (OR 0.54, 95% CI 0.37–0.79, p = 0.001) and shorter hospital stay (MD − 0.92 days, 95% CI − 1.67 to − 0.18, p = 0.02). No significant differences were found in mortality, anastomotic leak, bile leak, pancreatic fistula, operative time, blood loss, time to first flatus, or time to oral intake. Subgroup analysis revealed geographic variations in delayed gastric emptying outcomes.

Conclusion

Roux-en-Y reconstruction offers superior postoperative morbidity outcomes and shorter hospital stays compared to Billroth II, without increasing delayed gastric emptying or other complications. These findings support Roux-en-Y as the preferred reconstruction when Billroth I is not feasible.