ReviewCureus2026
A Systematic Review and Meta-Analysis: Does Braun Anastomosis Improve Billroth II Reconstruction After Distal Gastrectomy?
Review in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
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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