Billroth I reconstruction shows clear advantages over Roux-en-Y in laparoscopic distal gastrectomy for early efficiency and outcomes.

• Operative time: 216.6 min for Billroth I vs 251.7 min for Roux-en-Y (p = .016)
• Blood loss: 33 ml for Billroth I vs 105 ml for Roux-en-Y (p = .003)
• Hospital stay: 6.7 days for Billroth I vs 10.0 days for Roux-en-Y (p = .044)

Both techniques had comparable major morbidity (7% vs 11%) and no 30-day mortality.

Surgeons should consider Billroth I for patients needing faster recovery, while Roux-en-Y may be better for reflux control.