A Systematic Review and Meta-Analysis: Does Braun Anastomosis Improve Billroth II Reconstruction After Distal Gastrectomy?

TL;DR

This study finds that adding a Braun anastomosis to Billroth II reconstruction after stomach surgery does not significantly reduce bile reflux or complications, but it does increase surgery time.

Contribution

The study provides the first meta-analysis comparing Billroth II with and without Braun anastomosis for distal gastrectomy outcomes.

Findings

B-II with Braun anastomosis did not reduce bile reflux compared to B-II alone.

B-II+Braun had a longer operative time than B-II alone.

Anastomotic complications were similar between the two techniques.

Abstract

For various surgical indications, distal gastrectomy with Billroth II (B-II) reconstruction is a common technique. Still, this technique is frequently accompanied by bile reflux and post-gastrectomy syndromes. Braun jejunojejunostomy is performed as an anti-reflux modification, but its benefits relative to B-II alone remain unknown. This systematic review and meta-analysis aims to assess the effects of B-II plus Braun anastomosis in comparison to B-II alone. We conducted a detailed search across PubMed, Scopus, and Web of Science from their inception up to November 2025 to identify pertinent studies comparing B-II+Braun anastomosis with B-II alone after distal gastrectomy. The potential risk of bias of the included studies was assessed using the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) quality assessment tool. The meta-analysis was conducted using RevMan v.5.4 (Cochrane Collaboration, London, UK) employing a random-effects model. We identified eight retrospective studies (n = 2038 patients). Results of meta-analysis showed no difference in bile reflux incidence between B-II+Braun and B-II alone (RR: 0.95, 95% CI: 0.76-1.18). Early postoperative bile reflux showed a borderline reduction (RR: 0.57, 95% CI: 0.32-1.01). Anastomotic bleeding (RR: 0.94, 95% CI: 0.29-3.02) and fistula risk (RR: 1.17, 95% CI: 0.54-2.55) were comparable, and B-II+Braun had a longer operative time compared to B-II alone (mean difference: 19.07 minutes, 95% CI: 4.76-33.38). B-II with Braun enteroenterostomy offers no persistent benefits over the traditional B-II for bile reflux, anastomotic complications, or perioperative outcomes, and it increases operative time. This meta-analysis supports a personalized approach to reconstruction over the default Braun modification and underscores the need for further substantive comparative studies.

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