title: Braun enteroenterostomy is associated with reduced delayed gastric emptying and early resumption of oral feeding following pancreaticoduodenectomy.
abstract: OBJECTIVE
  Morbidity rates following pancreaticoduodenectomy (PD) remain high with delayed gastric emptying (DGE) and slow resumption of oral diet contributing to increased postoperative length of stay. A Braun enteroenterostomy has been shown to decrease bile reflux following gastric resection. We hypothesize that addition of Braun enteroenterostomy during PD would reduce the sequelae of DGE.
  
  
  METHODS
  From our PD database, patients were identified that underwent classic PD with partial gastrectomy from 2001 to 2006. All patients with reconstruction utilizing a single loop of jejunum at the University of Florida Shands Hospital were reviewed. Demographics, presenting signs and symptoms, pathologic diagnoses, and postoperative morbidity were compared in those patients undergoing reconstruction with an additional Braun enteroenterostomy (n = 70) to those not undergoing a Braun enteroenterostomy (n = 35).
  
  
  RESULTS
  Patients undergoing a Braun had NG tubes removed earlier (Braun: 2 days, no Braun: 3 days, P = 0.002) and no significant change in postoperative vomiting (Braun: 27%, no Braun: 37%, P = 0.37) or NG tube reinsertion rates (Braun: 17%, no Braun: 29%, P = 0.21). Median postoperative day with tolerance of oral liquids (Braun: 5, no Braun: 6, P = 0.01) and solid diets (Braun: 7, no Braun: 9, P = 0.01) were significantly sooner in the Braun group. DGE defined by two criteria including the inability to have oral intake by postoperative day 10 (Braun: 10%, no Braun: 26%, P < 0.05) and the international grading criteria (grades B and C, Braun: 7% vs. no Braun: 31%, P = 0.003) were significantly reduced in those undergoing the Braun procedure. In addition, the median length of stay (Braun: 10 days, no Braun: 12 days, P < 0.05) was significantly reduced in those undergoing the Braun procedure. The rate of pancreatic anastomotic failure was similar in the two groups (Braun: 17% vs. no Braun: 14%, P = 0.79). Median bile reflux was 0% in those undergoing a Braun.
  
  
  CONCLUSIONS
  The present study suggests that Braun enteroenterostomy can be safely performed in patients undergoing PD and may reduce the indicence of DGE and its sequelae. Further studies of Braun enteroenterostomy in larger randomized trials of patients undergoing PD are warranted.
authors.affiliation: Division of Surgical Oncology and Endocrine Surgery, University of Florida College of Medicine, Gainesville, Florida 32610, USA. steven.hochwald@surgery.ufl.edu
authors.forename: Steven N
authors.initials: SN
authors.lastname: Hochwald
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Grobmyer
authors.forename: Alan W
authors.initials: AW
authors.lastname: Hemming
authors.forename: Eleanor
authors.initials: E
authors.lastname: Curran
authors.forename: David A
authors.initials: DA
authors.lastname: Bloom
authors.forename: Matthew
authors.initials: M
authors.lastname: Delano
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Behrns
authors.forename: Edward M
authors.initials: EM
authors.lastname: Copeland
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Vogel
mesh_terms: D000368:Aged; D001655:Bile Reflux / Q000209:etiology; D005743:Gastrectomy; D005746:Gastric Emptying; D005763:Gastroenterostomy; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology