Billroth II with Braun anastomosis aimed to reduce duodenal fluid and bile entering the remnant gastric for reduce the possibility of alkaline reflux gastritis, The radionuclide demonstrated the diversion effect of Braun's anastomosis and provided a theoretical basis[16-17]. However, related studies have shown that the anti-reflux effect of Braun anastomosis is limited, and the incidence of alkaline reflux gastritis is still high. Park et al reported a high incidence (43.3%)of bile reflux in B-II with Braun anastomosis patients .Therefore, some researchers have proposed that Roux-en-Y or uncut Roux-en-Y reconstruction may be an alternative to with Braun reconstruction[20-21].
On the basis of Billroth II with Braun anastomos ,uncut Roux-en-Y anastomosisis is close without break the proximal jejunum input loop,In 2005, Uyama et al  reported laparoscopic uncut Roux-en-Y anastomosis, and found that this anastomosis can effectively reduce the incidence of RSS and improve the quality of life of patients. A prospective study shows that traditional Roux-en-Y anastomosis and uncut Roux-en-Y anastomosis are superior to other anastomosis in preventing bile reflux. In addition, compared with Roux-en-Y anastomosis, uncut Roux-en-Y anastomosis can reduce the incidence of Roux Stasis Syndrome, shorten the time of intraoperative digestive tract reconstruction, and reduce intraoperative bleeding. These studies confirm the safety and reliability of uncut Roux-en-Y anastomosis[23-24].
The uncut Roux-en-Y anastomosisis restricts bile and duodenal fluid from entering the residual stomach and reduces the possibility of alkaline reflux gastritis and esophagitis. Compared with Roux-en-Y anastomosis, uncut Roux-en-Y anastomosis keeps the continuity of jejunum structure, avoids the occurrence of ectopic pacers in jejunum and makes jejunum reverse peristalsis, reduces the occurrence of Roux Stasis Syndrome and improves the postoperative quality of life of patients[25-26].In this study, RSS was not observed in the uncut Roux-en-Y anastomosis group.Gastroscopy was performed 1-year postoperative, the incidence of food retention, residual gastritis and bile reflux were 19.8% vs. 37.0%, 11.6% vs. 34.2% and 1.2% vs. 28.8% in the uncut Roux-en-Y anastomosis group and Billroth II with Braun anastomosis group, respectively,these differences were statistically significant differences(p<0.05).In addition, there were 2 cases of reflux esophagitis in the B-II with Braun anastomosis group,rate of 2.7%,There was no statistical significance between the two groups(p>0.05).Quality of life was evaluated by QLQ-C30 questionnaire 1-year postoperative, and there was no statistical significance in all scores(p>0.05). When evaluated by QLQ-STO22 questionnaire, the scores of pain and reflux symptom in the uncut Roux-en-Y anastomosis group were lower than those in the Billroth II with Braun anastomosis group, and the differences were statistically significant(P<0.05), indicating that there were fewer reflux and pain symptoms in the uncut Roux-en-Y anastomosis group and relatively good quality of life.In addition, in the B-II with Braun anastomosis group, residual gastritis and bile reflux was indicated in some patients, but no obvious clinical symptoms were found. Therefore, long-term follow-up evaluation of postoperative quality of life in both groups is still needed to obtain reliable evidence.
In this study, the characteristics of patients in the two groups were consistent, and there was no significant difference in the safety of the two anastomosis methods. Although the rate of anastomotic leakage, duodenal stump leakage and Clavein-DindoIII complications in uncut Roux-en-Y anastomosis group was lower than that of Billroth II with Braun anastomosis, the difference was not statistically significant.There was no significant difference in nutritional indexes (including hemoglobin, lymphocyte count, total protein, albumin and body weight) between the two groups 1- year postoperative(p>0.05).
For the uncut Roux-en-Y anastomosis does not need to disconnect jejunum, the integrity of mesangial vessels is retained, the operation time is shortened, and intraoperative bleeding is reduced. At the same time, the blood supply of jejunum side of anastomosis was guaranteed and the probability of anastomotic leakage was reduced.However, the main problem of uncut Roux-en-Y anastomosis is recalcification of the closure point, which makes the jejunum input loop change from closed to open state, resulting in bile and duodenal fluid reflux into the residual gastric, causing alkaline reflux gastritis and esophagitis, affecting the postoperative quality of life of patients.Some studies[20、21、23] have reported that the incidence of recassation of uncut Roux-en-Y anastomosis is 0~22%, Recanalization was reported mostly with 3 or 4 rows of nail closure device, while recanalization rarely occurred with 6 rows of nail closure device, which may be due to the large pressure of intestinal loop at the closure site. With the expansion of intestinal peristalsis and pressure conduction, the anastomosis nail is deformed and loose, and the recanalization is not firmly closed. However, the 6-row screw closure device adds two rows of screws on the basis of the 4-row screw, which significantly improves the closure effect. However, its high price increases the economic burden of patients to some extent.This research adopts the 7 # silk in the proximal stomach jejunum anastomotic ligation jejunal loops of input 5 cm, ligation tied by appropriate force to ensure that loose thread ligation firm do not slip. 1- year follow up, 86 patients underwent gastroscopy, and some patients underwent upper gastrointestinal iodine-water angiography, recanalization of jejunum input loop was not observed.The main reasons are as follows: 1. The uncut Roux-en-Y anastomosis is pro-peristalsis anastomosis, the peristalsis direction of residual stomach and jejunum is consistent, which reduces the probability of food residue at the blind end of jejunum input loop ,avoids the increase of pressure at jejunum closure, 2. the 7# silk was used to ligation the intestinal,due to the inelasticity of the silk, the expansion of the intestinal wall at the closed place was limited. At the same time, the intestinal wall at the closed place was gradually fibrosis due to ischemia, resulting in atrettage, which further strengthened the firmness of the intestinal wall at the closed place.