***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIM To identify which technique is better for avoiding biliary reflux and gastritis between  uncut Roux-en-Y and Billroth II reconstruction . METHODS A total of 158 patients who underwent laparoscopy-assisted distal gastrectomy for gastric cancer at the First Hospital of Jilin University ( Changchun , China ) between February 2015 and February 2016 were r and omized into two groups : uncut Roux-en-Y ( group U ) and Billroth II group ( group B ) . Postoperative complications and relevant clinical data were compared between the two groups . RESULTS According to the r and omization table , each group included 79 patients . There was no significant difference in postoperative complications between groups U and B ( 7.6 % vs 10.1 % , P = 0.576 ) . During the postoperative period , group U stomach pH values were lower than 7 and group B pH values were higher than 7 . After 1 year of follow-up , group B presented a higher incidence of biliary reflux and alkaline gastritis . However , histopathology did not show a significant difference in gastritis diagnosis ( P = 0.278 ) , and the amount of residual food and gain of weight between the groups were also not significantly different . At 3 mo there was no evidence of partial recanalization of uncut staple line , but at 1 year the incidence was 13 % . CONCLUSION Compared with Billroth II reconstruction , uncut Roux-en-Y reconstruction is secure and feasible , and can effectively reduce the incidence of alkaline reflux , residual gastritis , and heartburn . Despite the incidence of recanalization , uncut Roux-en-Y should be widely applied To determine the clinical efficacy of Roux-en-Y reconstruction ( RY )  after distal gastrectomy , we compared postoperative outcomes of patients who underwent RY or conventional Billroth I reconstruction ( B-I ) .  A total of 50 patients were prospect ively r and omized to either B-I or RY reconstruction  , and complications , postoperative course , and nutritional status were compared . Bile reflux and inflammation in the remnant stomach and lower esophagus were evaluated by postoperative follow-up endoscopy at 6 months . Operative time and blood loss as well as postoperative nutrition did not show significant differences between the two groups . As anticipated , 5 of 24 patients with RY reconstruction  developed gastrojejunal stasis in the early postoperative period , which led to a longer postoperative hospital stay as compared with the B-I group ( mean ± S.D ; B-I ; 19.0 ± 6.2 , RY ; 31.8 ± 21.7 days ) ( P < 0.05 ) . Endoscopic examination revealed that the frequency of bile reflux ( P < 0.01 ) and degree of inflammation in the remnant stomach ( P < 0.05 ) were less in the RY group than in the B-I group . However , inflammatory findings in the lower esophagus were observed in 7 ( 27 % ) of B-I , and 8 ( 35 % ) of the RY group , suggesting that late phase esophagitis was not improved in the RY group . Roux-en-Y reconstruction was effective in preventing duodenogastric reflux and result ing gastritis , but it did not prevent esophagitis . Because RY reconstruction induces the frequent complication of Roux-en-Y stasis , causing longer postoperative hospital stay , this method has limited advantages over B-I anastomosis after distal gastrectomy Purpose The Roux en Y method has rarely been performed due to longer operation time and high risk of complication , despite several merits including prevention of bile reflux . We conducted a retrospective review of the result of Roux en Y reconstruction using two circular staplers  after subtotal gastrectomy . Material s and Methods From December 2008 to May 2009 , a total of 26 patients underwent Roux en Y reconstruction using two circular staplers after subtotal gastrectomy , and seventy-two patients underwent Billroth-I reconstruction . Roux en Y anastomosis was performed using two circular staplers without h and sewing anastomosis . We compared clinicopathologic features and surgical outcomes between the two groups . All patients underwent gastrofiberscopy  between six and twelve months after surgery to compare the bile reflux . Results No significant differences in clinicopathologic findings were observed between the two groups , except for the rate of minimal invasive surgery ( P=0.004 ) and cancer stage ( P=0.002 ) . No differences in the rate of morbidity ( P=0.353 ) and admission duration ( P=0.391 ) were observed between the two groups . Gastrofiberscopic findings showed a significant reduction of bile reflux in the remnant stomach in the Roux en Y group ( P=0.019 ) . Conclusions When compared with Billroth-I reconstruction , Roux en Y reconstruction using the double stapler technique was found to reduce bile reflux in the remnant stomach without increasing postoperative morbidity . Based on these results , we planned to begin a r and omized controlled clinical trial for comparison of Roux en Y reconstruction using this method with Billroth-I anastomosis Background We performed this prospect i ve r and omized study to evaluate what is the best reconstruction method after distal gastrectomy for gastric cancer . Methods One hundred fifty-nine patients who underwent laparoscopy-assisted or open gastrectomy for gastric cancer were analyzed from March 2006 to August 2007 .  Billroth I ( B-I ) anastomosis , Billroth II ( B-II ) with Braun anastomosis , and Roux-en-Y ( R-Y ) anastomosis were applied r and omly . Additionally , the patients were divided into two groups based on treatment type : laparoscopic and open operation . Endoscopy and hepatobiliary scans were performed to investigate gastric stasis and enterogastric reflux . The Gastrointestinal Quality of Life Index ( GIQLI ) was used to evaluate postoperative quality of life , and the hematologic test was used to assess nutritional aspect . Results Endoscopy revealed that reflux after the R-Y anastomosis procedure was significantly less frequent than after the other anastomosis types at 12 months . Comparison of the GIQLI and the nutritional parameters between the reconstruction types revealed that there were no differences , but a significantly higher GIQLI score was observed in the laparoscopic group immediately following the procedure ( P = 0.042 ) . Conclusions R-Y anastomosis is superior to B-I and B-II with Braun anastomosis in terms of frequency of bile reflux , despite the fact that there is no difference in the postoperative quality -of-life index and nutritional status between reconstructive procedures . The laparoscopic approach is the better option than open surgery in terms of QOL in the immediate postoperative period Background Laparoscopic gastrectomy has recently been gaining popularity as a treatment for cancer ; however , little is known about the benefits of intracorporeal ( IC ) gastrointestinal anastomosis with pure laparoscopic distal gastrectomy ( LDG ) compared with extracorporeal ( EC ) anastomosis with laparoscopy-assisted distal gastrectomy ( LADG ) . Methods Between June 2000 and December 2011 , we assessed 449 consecutive patients with early-stage gastric cancer who underwent LDG .  The patients were classified into three groups according to the method of reconstruction LADG followed by EC h and -sewn anastomosis ( LADG + EC ) ( n = 73 ) , using any of three anastomosis methods ( Billroth-I ( B-I ) , Billroth-II ( B-II ) or Roux-en-Y ( R-Y ) ; LDG followed by IC B-I anastomosis ( LDG + B-I ) ( n = 248 ) ; or LDG followed by IC R-Y anastomosis ( LDG + R-Y ) ( n = 128 ) ) . The analyzed parameters included patient and tumor characteristics , operation details , and post-operative outcomes . Results The tumor location was significantly more proximal in the LDG + R-Y group than in the LDG + B-I group ( P < 0.01 ) . Mean operation time , intra-operative blood loss , and the length of post-operative hospital stay were all shortest in the LDG + B-I group ( P < 0.05 ) . Regarding post-operative morbidities , anastomosis-related complications occurred significantly less frequently in with the LDG + B-I group than in the LADG + EC group ( P < 0.01 ) , whereas there were no differences in the other parameters of patients ’ characteristics . Conclusions Intracorporeal mechanical anastomosis by either the B-I or R-Y method following LDG has several advantages over at the LADG + EC , including small wound size , reduced invasiveness , and safe anastomosis . Although additional r and omized control studies are warranted to confirm these findings , we consider that pure LDG is a useful technique for patients with early gastric cancer Purpose Intracorporeal anastomosis during laparoscopic gastrectomy is becoming increasingly prevalent . However , selection of the anastomosis method after laparoscopic distal gastrectomy is equivocal because of a lack of technical feasibility and safety . We compared intracorporeal gastroduodenostomy with gastrojejunostomy using linear staplers to evaluate the technical feasibility and safety of intracorporeal anastomoses as well as its ' minimally invasiveness . Material s and Methods Retrospective analyses of a prospect ively collected data base for gastric cancer revealed 47 gastric cancer patients who underwent laparoscopic distal gastrectomy with either intracorporeal gastroduodenostomy or gastrojejunostomy from March 2011 to June 2011 . Perioperative outcomes such as operation time , postoperative complication , and hospital stay were compared according to the type of anastomosis . Postoperative inflammatory response was also compared between the two groups using white blood cell count and high sensitivity C-reactive protein . Results Among the 47 patients , 26 patients received gastroduodenostomy , whereas 21 patients received gastrojejunostomy without open conversion or additional mini-laparotomy incision . There was no difference in mean operation time , blood loss , and length of postoperative hospital stays . There was no statistically significant difference in postoperative complication or mortality between two groups . However , significantly more staplers were used for gastroduodenostomy than for gastrojejunostomy ( n=6 ) than for gastroduodenostomy and ( n=5 ) . Conclusions Intracorporeal anastomosis during laparoscopic gastrectomy using linear stapler , either gastroduodenostomy or gastrojejunostomy , shows comparable and acceptable early postoperative outcomes and are safe and feasible . Therefore , surgeons may choose either anastomosis method as long as oncological safety is guaranteed OBJECTIVE Intracorporeal reconstruction of the digestive tract is technically challenging . The V-Loc 180 wound closure device ( Covidien ) is a self-anchoring unidirectional barbed suture that obviates the need for knot tying . The aim of this prospect i ve cohort study was to investigate the use of the novel suture in gastrointestinal enterotomy closure . METHODS The subjects comprised patients with malignant disease who were scheduled to undergo laparoscopic gastrectomy with curative intent . The barbed suture was used to close the entry hole for the linear stapler during intracorporeal reconstruction following laparoscopic gastric resection . The primary endpoint was the proportion of patients who developed anastomotic leakage at the site where the barbed suture was applied . RESULTS Between July 2012 and March 2015 , 242 patients were enrolled . Of 362 anastomoses , the enterotomy hole at 256 sites was closed using the barbed suture . These 256 sites consisted of 95 gastroduodenostomies , 25 gastrogastrostomies , 13 gastrojejunostomies , 90 jejunojejunostomies , 17 esophagojejunostomies and 16 primary closures of the stomach following local gastric resection . There were no anastomosis-related complications , conversion to usual sutures , mechanical closure of the entry hole and reoperation due to adhesive obstructions or mortality over a median follow-up period of 17.8 months . CONCLUSIONS The use of the unidirectional barbed absorbable suture for gastrointestinal closure is safe and effective in laparoscopic gastrectomy The purpose of this study is to compare the effect of diabetes control induced by Roux-en-Y gastrojejunostomy(RY ) vs Billroth-I reconstruction(BI ) after distal gastrectomy in patients with early gastric cancer(EGC ) and type 2 diabetes(T2DM ) . Forty EGC patients with T2DM , aged 20–80 years , who were expected to undergo curative distal gastrectomy were r and omized 1:1 to RY(n = 20 ) or BI(n = 20 ) . Diabetes medication status , biochemical and hormonal data including blood glucose , HbA1c , insulin , C-peptide , HOMA-IR , ghrelin , leptin , GLP-1 , PYY , and GIP were evaluated for 12 months after surgery . Although pre- and postoperative 12-month fasting and postpr and ial glucose levels did not 
    Output:
    
Conclusions Our study is the first meta- analysis comparing anastomoses in LDG and introduces novel criteria for consideration when selecting reconstructions in LDG .