Roux-en-Y and Billroth II Reconstruction after Pancreaticoduodenectomy: A Meta-Analysis of Complications

Objective To evaluate Roux-en-Y and Billroth II reconstruction following pancreaticoduodenectomy (PD). Methods PubMed, Embase, the Cochrane Library, and the Web of Science were searched to identify randomized controlled trials (RCTs) and controlled clinical trials that compared Roux-en-Y and Billroth II reconstruction following PD up to December 2019. RevMan 5.3 software was used for the statistical analysis. Results Four RCTs and five controlled clinical trials were included, with a total of 1,072 patients (500 and 572 patients in the Roux-en-Y and Billroth II groups, respectively). No significant differences in delayed gastric emptying (DGE), A-grade DGE, B-grade DGE, or C-grade DGE were observed between the Roux-en-Y and Billroth II reconstruction groups after PD (odds ratio [OR] = 1.01, 95% confidence interval [CI]: 0.50-2.03, P = 0.98; OR = 0.49, 95% CI: 0.17-1.45, P = 0.20; OR = 0.63, 95% CI: 0.29-1.38, P = 0.25; and OR = 2.13, 95% CI: 0.38-11.99, P = 0.39). No significant difference in the incidence of postoperative pancreatic fistula, abscess, bile leaks, infection, postoperative bleeding, or the length of the postoperative hospital stay was observed between the Roux-en-Y and Billroth II groups (P > 0.05), but the operation time was significantly different (mean difference [MD] = 31.65, 95% CI: 7.14-56.17, P = 0.01). Conclusions Billroth II reconstruction after PD did not significantly reduce the incidence of DGE or other complications but shortened the operation time compared to Roux-en-Y reconstruction. However, the results must be verified by further high-quality, large RCTs or controlled clinical trials.