AIM: The study aimed to investigate the influence of Billroth II combined with Braun anastomosis on perioperative stress indicators and pepsinogens in patients undergoing laparoscopic gastric cancer surgery.

METHODS: This study is a single-center retrospective research design. This study included 148 patients who underwent laparoscopic radical distal gastrectomy for gastric cancer between March 2021 and June 2024, with all surgical procedures performed by the same surgical team. According to the digestive tract reconstruction methods, participants were divided into a Billroth II group (n = 63) and a Billroth II+Braun group (n = 85). The short-term efficacy outcomes included perioperative stress indicators, pepsinogen I to pepsinogen II ratio (PGR), Gastrin-17 (G-17), and postoperative complications. Moreover, the long-term efficacy outcomes comprised bile reflux rate, incidence rate of reflux residual gastritis and 1-year survival rate.

RESULTS: The C-reactive protein (CRP) showed a gradual increase preoperatively (T0) and at postoperative day 1 (T1) and day 2 (T2) (F _interaction = 2.74, p = 0.064; F _time-point = 757.8, p < 0.001; F _{between-group} = 2.50, p = 0.114). However, norepinephrine (NE) and cortisol (COR) initially increased and then declined at these time points (F _interaction = 0.90, 0.58, p = 0.407, 0.559; F _time-point = 1628, 466.4, both p < 0.001; F _{between-group} = 0.83, 0.70, p = 0.36, 0.40). Furthermore, no statistical differences in CRP, NE and COR were observed between the Billroth II+Braun group and the Billroth II group at the three time points (p > 0.05). Compared with preoperative levels (T0), PGR increased in both groups, whereas G-17 decreased at postoperative day 30 (T3) (p < 0.01). Additionally, PGR was significantly higher in Billroth II+Braun group (p < 0.001) while there was no statistical difference in G-17 between the two groups at T3 (p = 0.943). Similarly, the anastomotic leakage (Fisher’s exact test, p = 0.312), anastomotic stenosis (Fisher’s exact test, p = 1.000), duodenal stump bleeding (Fisher’s exact test, p = 0.426), duodenal stump leakage (Fisher’s exact test, p = 0.180), and intestinal obstruction rate (Fisher’s exact test, p = 0.402) also showed no statistical differences between the two groups. The bile reflux rate was substantially lower in the Billroth II+Braun group (p = 0.005), while no statistical differences were observed in residual food (p = 0.097), reflux residual gastritis (Fisher’s exact test, p = 0.312) and survival rate (Fisher’s exact test, p = 0.700) between groups.

CONCLUSIONS: This study demonstrates that Billroth II+Braun anastomosis and Billroth II anastomosis are equally safe and effective during radical distal gastrectomy for gastric cancer. There is no significant difference in the influence of two digestive tract reconstruction methods on perioperative stress indicators in this cohort. Additionally, Billroth II+Braun anastomosis can improve PGR level and reduce bile reflux rate.