title: A comparative study of delta-shaped and conventional Billroth I anastomosis after laparoscopic distal gastrectomy for gastric cancer.
abstract: Delta-shaped anastomosis (DA) is a newly developed intracorporeal gastroduodenostomy. This meta-analysis is performed to compare the safety, feasibility and clinical outcomes of DA with conventional extracorporeal Billroth I anastomosis (B-I) after laparoscopic distal gastrectomy for gastric cancer.
  
  
  
  Both randomized controlled trials (RCTs) and nonrandomized cohort studies comparing outcomes of DA and B-I after laparoscopic distal gastrectomy for gastric cancer were searched in electronic database. Surgical outcomes, postoperative recovery, postoperative complications and outcomes were pooled and compared by meta-analysis using RevMan 5.3 software. Weighted mean differences (WMDs), odds ratios and risk differences were calculated with 95% confidence intervals (CIs). P values of <0.05 were considered statistically significant.
  
  
  
  Eight nonrandomized cohort studies of 2450 patients were included. Meta-analysis showed significantly less blood loss (WMD -28.72; 95% CI -49.21 to -8.23; P = 0.006), more lymph nodes retrieved (WMD 3.23; 95% CI 0.86-5.61; P = 0.008), shorter time to first soft diet (WMD -0.34; 95% CI -0.47 to -0.21, P < 0.00001), less pain and analgesic use (WMC -0.29; 95% CI -0.56 to -0.02; P = 0.03) in DA than in B-I. Both methods had similar operative time, resection margin, time to first flatus, length of hospital stay and rate of complications. Most of the postoperative symptoms were comparable between groups. The subgroup of obese patient showed more favorable outcomes in DA, and the learning curve of DA is steep.
  
  
  
  DA is a safe and feasible reconstruction method after laparoscopic distal gastrectomy, with comparable postoperative surgical outcomes, postoperative complications comparing to B-I. DA is less invasive with quicker resume of diet than B-I, especially for the obese patients.
authors.affiliation: Department of General Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China.|Huashan Worldwide Medical Center, Huashan Hospital, Fudan University, Shanghai, 200040, China.
authors.forename: Shu-Yan
authors.initials: SY
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Hong
authors.affiliation: Department of General Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China. hhk_hs@hotmail.com.
authors.forename: Han-Kun
authors.initials: HK
authors.lastname: Hao
mesh_terms: D005743:Gastrectomy / Q000379:methods*; D005763:Gastroenterostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D061646:Operative Time; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Billroth I anastomosis; Delta-shaped anastomosis; Gastric cancer; Laparoscopic distal gastrectomy; Meta-analysis