Background: Although Roux-en-Y (R-Y) reconstruction after distal gastrectomy has several merits such as prevention of bile reflux into the remnant stomach, it is rarely used because of the technical difficulty. This study aimed to show the efficacy of a novel method of R-Y reconstruction involving the use of 2 circular staplers through a prospective randomized clinical trial comparing the novel method with Billroth-I (B-I) reconstruction.
Materials and Methods: 118 patients were randomly allocated into the RY (59 patients) and B-I reconstruction (59 patients) groups. R-Y anastomosis was performed using 2 circular staplers and no hand sewing. The primary end-point of this clinical trial was the reflux of bile into the remnant stomach, and it was evaluated through endoscopic and histological findings at 6 months after surgery.
Results: No significant differences were observed in the clinicopathologic findings between the 2 groups. Although anastomosis time (P < 0.001) was significantly longer for the patients of the R-Y group than them for the B-I group, there was no difference between the 2 groups in terms of the total surgery duration (P = 0.112). Endoscopic findings showed a significant reduction of bile reflux in the remnant stomach in the R-Y group (P < 0.001), and the histological findings showed that reflux gastritis was more significant in the B-I group than in the R-Y group (P = 0.026).
Conclusions: The results of our randomized controlled clinical trial showed that compared with B-I reconstruction, R-Y reconstruction using circular staplers is a safe and feasible procedure.