Short- and Mid-Term Surgical Outcomes of Billroth I Versus Billroth II/Roux-en-Y Reconstruction: A Prospective Cohort Study in Gastric Cancer Patients

Background and Objectives: The best method for reconstructing the stomach after distal gastrectomy surgery in gastric cancer patients continues to be a subject of ongoing discussion. The most beneficial surgical option for patients is Billroth I (BI) yet surgeons perform Billroth II and Roux-en-Y (BII/RY) procedures because of their easier execution, although their impact on recovery complications and postoperative function remains unclear. This prospective observational cohort study compared short- and mid-term surgical outcomes between BI and BII/RY reconstructions. Materials and Methods: The study included 150 patients who received curative-intent distal gastrectomy at the General Surgical Clinic of Emergency County Hospital in Târgu Mureș Romania from October 2021 through December 2024 (72 BI and 78 BII/RY patients). Outcomes included recovery parameters, postoperative complications (Clavien–Dindo), and mid-term functional results (PPI use, Los Angeles classification esophagitis, bile reflux gastritis, Sigstad dumping score). Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline covariates. Results: The results indicated that IPTW adjustment did not change the baseline demographics, tumor characteristics and perioperative factors. The study found no substantial variations between groups regarding time to flatus and oral diet initiation and hospital stay duration. The research revealed no substantial variations between the two groups regarding major morbidity (Clavien–Dindo ≥ III) and death rates at 30 and 90 days. The results of the mid-term functional assessment showed that BII/RY patients developed more bile reflux gastritis, but BI patients experienced dumping syndrome more often. Conclusions: The short-term surgical results, together with total postoperative complications, showed no difference between BI and BII/RY reconstruction methods. The study revealed distinct functional results between the two groups during the midterm assessment, which demonstrates that surgeons need to maintain their practice of choosing reconstruction techniques according to patient-specific requirements.