The effect of Braun enteroenterostomy on delayed gastric emptying after pancreaticoduodenectomy: A prospective study.

Backgrounds/aims: Pancreaticoduodenectomy (PD) is a surgical procedure commonly used for periampullary and pancreatic head tumors. Despite surgical advancements, postoperative morbidity remains substantial, with delayed gastric emptying (DGE) being a frequent complication. This prospective study evaluates the impact of Braun enteroenterostomy (BE) on DGE.

Methods: Twenty-five consecutive patients undergoing PD were enrolled between May 2023 and August 2024. The retrospective control group consisted of 72 patients who underwent standard PD during the previous four years. The primary outcome measured was the incidence of DGE. Secondary outcomes included the occurrence of postoperative complications and length of stay.

Results: The overall incidence of DGE was lower in the Braun group (33.3%) compared to the non-Braun group (46.8%) (p = 0.032). Grade B DGE was less frequent in the Braun group, and no Grade C DGE in either group. Braun group demonstrated a smaller mean pancreatic duct diameter (3.96 mm) than the non-Braun group (5.35 mm) (p = 0.011), yet there was a decrease in the incidence of clinically significant postoperative pancreatic fistula (POPF) (Grade B (8.3% vs 19.4%, p = 0.045) and no Grade C in the Braun group. The mean postoperative hospital stay was significantly shorter in the Braun group (12.5 days) versus the non-Braun group (15.7 days) (p = 0.027). Univariate analysis identified a history of weight loss and elevated CA19-9 associated with DGE, Grade B POPF as an independent risk factor for DGE.

Conclusions: Incorporating BE during PD correlates with a lower incidence of DGE, especially for Grades B and C, as well as a reduced rate of Grade B POPF and a shorter postoperative hospital stay.