Braun enteroenterostomy reduces delayed gastric emptying after pylorus-preserving pancreatoduodenectomy: a retrospective review

Watanabe, Yusuke; Ohtsuka, Takao; Kimura, Hideyo; Matsunaga, Taketo; Tamura, Koji; Ideno, Noboru; Aso, Teijiro; Miyasaka, Yoshihiro; Ueda, Junji; Takahata, Shunichi; Tanaka, Masao

doi:10.1016/j.amjsurg.2014.05.007

Cited by 32 publications

(43 citation statements)

References 37 publications

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“…The incidence of DGE Four studies [10,13,20,21] containing 1031 patients provided information on DGE grade B and grade C. The meta-analysis using a random-effects model showed a significant difference in the occurrence of DGE grade B between two groups (Fig. 3, OR, 0.24; 95%CI, 0.07 to 0.80; P ¼ 0.02; I 2 ¼ 52%).…”

Section: Delayed Gastric Emptyingmentioning

confidence: 97%

“…Pooled analysis revealed no significant difference in the rate of pancreatic fistula (7 studies [10,12,13,18e21]: OR, 0.70; 95%CI, 0.35 to 1.40; P ¼ 0.31; I 2 ¼ 69%), bile leakage (6 studies [10,12,18e21]: OR, 0.61; 95%CI, 0.34 to 1.08; P ¼ 0.09; I 2 ¼ 0%) and intra-abdominal abscess (5 studies [10,12,18,19,21]: OR, 0.92; 95%CI, 0.58 to 1.45; P ¼ 0.71; I 2 ¼ 0%) between Braun group and Non-Braun group.…”

Section: Pancreatic Fistula Bile Leakage and Intra-abdominal Abscessmentioning

confidence: 97%

“…Five studies [12,13,18,20,21] provided data on the LOS. However, only two articles [18,20] provide the standard deviation.…”

Section: Length Of Hospital Staymentioning

confidence: 99%

“…Three studies [18,20,21] were analyzed for intra-operative blood loss. The random-effects model was used because of significant heterogeneity (I 2 ¼ 97%) between these 3 studies, and the pooled effect indicated no difference between the two groups (WMD, À64.71; 95%CI, À239.94 to 110.52; p ¼ 0.47).…”

Section: Intra-operative Blood Lossmentioning

confidence: 99%

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Braun enteroenterostomy reduces delayed gastric emptying: A systematic review and meta-analysis

Huang

Mao

et al. 2015

International Journal of Surgery

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Section: Delayed Gastric Emptyingmentioning

confidence: 97%

Section: Pancreatic Fistula Bile Leakage and Intra-abdominal Abscessmentioning

confidence: 97%

“…Five studies [12,13,18,20,21] provided data on the LOS. However, only two articles [18,20] provide the standard deviation.…”

Section: Length Of Hospital Staymentioning

confidence: 99%

Section: Intra-operative Blood Lossmentioning

confidence: 99%

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Braun enteroenterostomy reduces delayed gastric emptying: A systematic review and meta-analysis

Huang

Mao

et al. 2015

International Journal of Surgery

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“…Some previous studies speculated that the prevention of bile reflux by Braun anastomosis may be involved in the mechanism of the reduced incidence of DGE [7,10] . However, no previous report compared the extent of real-time bile reflux into the stomach between pancreatoduodenectomy procedures with and without Braun anastomosis [7,[10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

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

Fujieda

Yokoyama²,

Hirata³

et al. 2017

Dig Surg

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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.

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Randomized trial of two types of gastrojejunostomy after pancreatoduodenectomy and risk of delayed gastric emptying (PAUDA trial)

Busquets

Martín

Fabregat

et al. 2018

British Journal of Surgery

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Background Delayed gastric emptying (DGE) is the most important cause of an extended hospital stay after pancreatoduodenectomy. Reports suggest that a Roux‐en‐Y gastroenteric anastomosis may have lower incidence of DGE than a Billroth II reconstruction. The primary aim of this RCT was to compare Billroth II (single loop) and Roux‐en‐Y (double loop) after pancreatoduodenectomy to determine whether Roux‐en‐Y reconstruction is associated with a lower incidence of DGE. Secondary endpoints were postoperative complications. Methods This was a randomized unblinded single‐centre trial without masked evaluation of the main outcome. Patients undergoing pancreatoduodenectomy between 2013 and 2015 were randomized to undergo one of two types of gastroenteric anastomosis for reconstruction. Results A total of 80 patients were randomized, 40 in each group. The incidence of DGE was the same in patients undergoing Billroth II or Roux‐en‐Y gastroenteric anastomosis (both 18 of 40 patients; P = 1·000). The grade of DGE was also similar in the Billroth II and Roux‐en‐Y groups (grade A, both 10 of 40; grade B, 5 of 40 versus 6 of 40; grade C, 3 of 40 versus 2 of 40; P = 0·962). The mortality rate was 3 per cent, with no significant difference between the two groups. There were no differences in the overall rate of postoperative morbidity, relaparotomy rate or duration of hospital stay. Conclusion The incidence and severity of DGE does not differ between single‐ or double‐loop gastroenteric anastomosis performed after pancreatoduodenectomy. Registration number: NCT00915863 (http://www.clinicaltrials.gov).

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Braun enteroenterostomy reduces delayed gastric emptying after pylorus-preserving pancreatoduodenectomy: a retrospective review

Cited by 32 publications

References 37 publications

Braun enteroenterostomy reduces delayed gastric emptying: A systematic review and meta-analysis

Braun enteroenterostomy reduces delayed gastric emptying: A systematic review and meta-analysis

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

Randomized trial of two types of gastrojejunostomy after pancreatoduodenectomy and risk of delayed gastric emptying (PAUDA trial)

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