title: Different features of complications with Billroth-I and Roux-en-Y reconstruction after laparoscopy-assisted distal gastrectomy.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Koshi
authors.initials: K
authors.lastname: Kumagai
authors.forename: Naoki
authors.initials: N
authors.lastname: Hiki
authors.forename: Souya
authors.initials: S
authors.lastname: Nunobe
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Jiang
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kubota
authors.forename: Susumu
authors.initials: S
authors.lastname: Aikou
authors.forename: Ryohei
authors.initials: R
authors.lastname: Watanabe
authors.forename: Shinya
authors.initials: S
authors.lastname: Tanimura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sano
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yamaguchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects*; D005260:Female; D005743:Gastrectomy; D005763:Gastroenterostomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007564:Japan; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*