Does Braun Anastomosis Have an Impact on the Incidence of Delayed Gastric Emptying and the Extent of Intragastric Bile Reflux Following Pancreatoduodenectomy? - A Randomized Controlled Study

Abstract

Background/Aims: This study investigated the impact of Braun anastomosis on the incidence of delayed gastric emptying (DGE) and on the intragastric bile reflux after pancreatoduodenectomy with Child reconstruction. Methods: Sixty-eight patients who underwent subtotal stomach-preserving pancreatoduodenectomy were included. Patients were randomly assigned to a group with or without Braun anastomosis intraoperatively. Twenty-four-hour intragastric bilirubin monitoring was performed to investigate the extent of intragastric bile reflux after surgery. The incidence of DGE and other complications was also monitored. Results: There were no differences between the non-Braun and Braun groups in terms of patient characteristics. The incidence rate of DGE was 29.4% (n = 10/34) in the non-Braun group and 20.6% (n = 7/34) in the Braun group (p = 0.401). Forty-six of the 68 patients consented to intragastric bilirubin monitoring. The fraction time of intragastric bilirubin reflux was comparable between the 2 groups. Although the fraction time of intragastric bilirubin reflux had no impact on the incidence of DGE, the incidence of pancreatic fistula was significantly higher in patients with DGE than those without DGE (47.1 vs. 21.6%, p = 0.043). Conclusion: The addition of Braun anastomosis after pancreatoduodenectomy did not effectively reduce the intragastric bile reflux and had minor impact in reducing the incidence of DGE.

Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials

“…Ages, gender mix and BMI were generally comparable between direct comparisons, although the single study comparing PR, retrocolic, Billroth II against PR, antecolic Billroth II had a male-predominant cohort (more than 70 per cent). Most studies were conducted in Asia (16 of 24; 67 per cent) 5 , 35 , 36 , 38–46 , 48 , 50 , 51 , 53 , 10 of which were in Japan 5 , 35 , 36 , 39 , 42 , 44 , 46 , 48 , 50 , 51 . Study characteristics are summarized in Table S1 .…”

Braun anastomosis lowers the incidence of delayed gastric emptying following pancreaticoduodenectomy: a meta-analysis

“…1 . The search strategy generated 11 articles [ 4 – 6 , 11 – 18 ] that fulfilled the inclusion criteria with a total of 1672 patients (1005 in Braun group and 667 in non-Braun group). The characteristics of the included studies are shown in Table 1 .…”

“…It also reduces tension on the anastomosis [ 11 , 12 ]. However, there are limited studies on the effectiveness of Braun enteroenterostomy on DGE following pancreaticoduodenectomy and the results are conflicting [ 4 – 6 , 11 – 18 ]. Meta-analysis provides a way to increase statistical power and resolve inconsistencies.…”

“…The incidence of pancreatic fistula also tended to be lower in Braun group with marginal statistical significance ( P = 0.06). The weight of three recent RCTs seems important in these findings and participated to increase the measured magnitude of effect size [ 4 – 6 ]. It could be hypothesized that Braun enteroenterostomy can decrease biliopancreatic limb pressures, thus decreasing the risk of biliary and pancreatic fistula.…”

“…To prevent DGE, Braun enteroenterostomy between the afferent and efferent limbs distal to the gastroenterostomy site was introduced and two meta-analyses of several non-randomized controlled trials (NRCTs) demonstrated that it could reduce the occurrence of DGE [ 2 , 3 ]. However, recent three randomized controlled trials (RCTs) failed to confirm this finding [ 4 – 6 ]. It seems that controversies still exist concerning the effect of Braun enteroenterostomy on DGE.…”