Effects of adding Braun jejunojejunostomy to standard Whipple procedure on reduction of afferent loop syndrome — a randomized clinical trial

Abstract

Background: Whipple surgery (pancreaticodeudenectomy) has a high complication rate. We aimed to evaluate whether adding Braun jejunojejunostomy (side-to-side anastomosis of afferent and efferent loops distal to the gastrojejunostomy site) to a standard Whipple procedure would reduce postoperative complications. Methods:We conducted a randomized clinical trial comparing patients who underwent standard Whipple surgery (standard group) and patients who underwent standard Whipple surgery with Braun jejunojejunostomy (Braun group). Patients were followed for 1 month after the procedure and postoperative complications were recorded.Results: Our study included 30 patients: 15 in the Braun and 15 in the standard group. In the Braun group, 4 (26.7%) patients experienced 6 complications, whereas in the standard group, 7 (46.7%) patients experienced 11 complications (p = 0.14). Complications in the Braun group were gastrointestinal bleeding and wound infection (n = 1 each) and delayed gastric emptying and pulmonary infection (n = 2 each). Complications in the standard group were death, pancreatic anastomosis leak and biliary anastomosis leak (n = 1 each); gastrointestinal bleeding (n = 2); and afferent loop syndrome and delayed gastric emptying (n = 3 each). There was no significant difference between groups in the subtypes of complications. Conclusion:Our results showed that adding Braun jejunojejunostomy to standard Whipple procedure was associated with lower rates of afferent loop syndrome and delayed gastric emptying. However, more studies are needed to define the role of Braun jejunojejunostomy in this regard. Trial registration: IRCT2014020316473N1 (www.irct.ir)Contexte : La chirurgie de Whipple (pancréatoduodénectomie) s'accompagne de taux de complications élevés. Nous avons voulu vérifier si l'ajout d'une jéjunojéjunostomie de Braun (anastomose latérolatérale des anses afférente et efférente à la partie distale de la gastrojéjunostomie) à une chirurgie de Whipple standard permet de réduire les complications postopératoires.

The clinical features of late postoperative cholangitis following pancreaticoduodenectomy brought on by conditions other than cancer recurrence: a single-center retrospective study

“…Stagnation of the flow of digestive juices in the jejunal loop can easily lead to reflux of digestive juices into the IHBD via anastomosis [ 18 ]. Shortening the jejunal loop to the minimum length necessary and adding the Braun's anastomosis may reduce pressure in the jejunal loop and prevent reflux of digestive fluids into the IHBD [ 20 ].…”

Impact of Gastric Resection and Enteric Anastomotic Configuration on Delayed Gastric Emptying after Pancreaticoduodenectomy: A Network Meta-analysis of Randomized Trials

“…1. The search identified 1215 studies, of which 24 RCTs met the inclusion criteria [2][3][4][5][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] . A total of 2647 patients were randomized and 2526 included in the analysis.…”

“…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][39][40][41][42][43][44][45][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.…”

Retrograde installation of percutaneous transhepatic negative-pressure biliary drainage stabilizes pancreaticojejunostomy after pancreaticoduodenectomy: a retrospective cohort study

“…Braun anastomosis is one of these two strategies; it reduces the pressure in the biliopancreatic limb to avoid the afferent loop syndrome. The result of a randomized clinical trial showed that Braun anastomosis might decrease the pressure in the biliopancreatic limb after standard Whipple’s operation [19]. Separating anastomoses is the other strategy.…”

“…Double Roux-en-Y reconstruction was proposed to isolate pancreaticoenteric, choledochoenteric, or gastroenteric anastomosis [21]. However, all these modified structures rendered no significant protection against pancreaticoenteric leakage [19–21].…”