title: Comparing the short-term outcomes of totally intracorporeal gastroduodenostomy with extracorporeal gastroduodenostomy after laparoscopic distal gastrectomy for gastric cancer: a single surgeon's experience and a rapid systematic review with meta-analysis.
abstract: BACKGROUND
  Since delta-shaped gastroduodenostomy was introduced, many surgeons have utilized laparoscopic distal gastrectomy (LDG) with totally intracorporeal Billroth I (ICBI) for gastric cancer, because it is expected to have several advantages over laparoscopic-assisted distal gastrectomy with extracorporeal Billroth I (ECBI). In this study, we compared these two reconstruction options to evaluate their outcomes.
  
  
  METHODS
  The data of 166 gastric cancer patients who underwent LDG performed by a single surgeon between April 2009 and February 2012 were analyzed retrospectively. The subjects were divided into ECBI (n = 106) and ICBI (n = 60) groups, and then the clinical characteristics, surgical outcomes, symptoms, and change in BMI at 3 months after surgery were compared. Furthermore, a rapid systematic review and meta-analysis were conducted.
  
  
  RESULTS
  The operative time was significantly shorter in the ICBI group (197.4 ± 45.5 vs. 157.1 ± 43.9 min), but blood loss was similar between the groups. Regarding surgical outcomes, there were no significant differences in the length of hospital stay, soft diet initiation, visual analogue scale, frequency of analgesics injection, and postoperative white blood cell counts and C-reactive protein levels between the groups. The surgical complication rates were 5.7 and 13.3% in the ECBI and ICBI groups, respectively, and one case of anastomosis leakage was observed in each group. At 3 months after surgery, reflux symptoms were more frequent in the ICBI group, but other gastrointestinal symptoms and the change of BMI were similar between the groups. The meta-analysis revealed no significant differences in the operative time, time to first flatus, length of hospital stay, frequency of analgesic usages, and rates of anastomosis complications between the groups.
  
  
  CONCLUSIONS
  We could not demonstrate the clinical superiority of ICBI over ECBI based on our data and a rapid systematic review and meta-analysis. The anastomosis method may be selected according to patient conditions and the surgeon's preference.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Deok Gie
authors.initials: DG
authors.lastname: Kim
authors.forename: Yoon Young
authors.initials: YY
authors.lastname: Choi
authors.forename: Ji Yeong
authors.initials: JY
authors.lastname: An
authors.forename: In Gyu
authors.initials: IG
authors.lastname: Kwon
authors.forename: In
authors.initials: I
authors.lastname: Cho
authors.forename: Yoo Min
authors.initials: YM
authors.lastname: Kim
authors.forename: Jung Min
authors.initials: JM
authors.lastname: Bae
authors.forename: Myung Gyu
authors.initials: MG
authors.lastname: Song
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Noh
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002097:C-Reactive Protein / Q000032:analysis; D004032:Diet; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005763:Gastroenterostomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D059408:Pain Management; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D002097:C-Reactive Protein