title: Reduction in delayed gastric emptying following non-pylorus preserving pancreaticoduodenectomy by addition of a Braun enteroenterostomy.
abstract: BACKGROUND
  Delayed gastric emptying is a major cause of morbidity following pancreaticoduodenectomy.
  
  
  OBJECTIVE
  The impact of a Braun enteroenterostomy on delayed gastric emptying, used in reconstruction following classic pancreaticoduodenectomy, was assessed.
  
  
  METHODS
  Forty-four consecutive patients undergoing non-pylorus preserving pancreaticoduodenectomy from 2009 to 2011 by a single surgeon were included in this study.
  
  
  METHODS
  The first 20 patients had a standard antecolic gastroenterostomy and the subsequent 24 had the addition of a Braun enteroenterostomy.
  
  
  RESULTS
  Patient characteristics, the extent of surgery, surgical findings and tumor characteristics were similar between the two groups. The delayed gastric emptying rate in the Braun enteroenterostomy (1/24, 4.2%) was significantly lower (P=0.008) than the standard reconstruction group (7/20, 35.0%). In the standard group, 6 of 7 cases (85.7%) of delayed gastric emptying were class C in nature. After exclusion of 8 total pancreatectomy patients, the pancreatic fistula rate in the Braun enteroenterostomy group (4/19, 21.1%) was similar (0.706) to the standard reconstruction group (5/17, 29.4%) as was the median length of hospital stay (10 days vs. 15 days; P=0.291). Braun enteroenterostomy technique was the only significant independent factor associated with reduced delayed gastric emptying with an odds ratio of 0.08 (95% confidence interval: 0.01-0.73; P=0.025).
  
  
  CONCLUSIONS
  The use of Braun enteroenterostomy following non-pylorus preserving pancreaticoduodenectomy appears to result in a significant reduction in delayed gastric emptying.
authors.affiliation: Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia. mehrdad.nikfarjam@gmail.com
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Nikfarjam
authors.forename: Nezor
authors.initials: N
authors.lastname: Houli
authors.forename: Farrukh
authors.initials: F
authors.lastname: Tufail
authors.forename: Laurence
authors.initials: L
authors.lastname: Weinberg
authors.forename: Vijayaragavan
authors.initials: V
authors.lastname: Muralidharan
authors.forename: Christopher
authors.initials: C
authors.lastname: Christophi
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005746:Gastric Emptying; D005763:Gastroenterostomy / Q000009:adverse effects / Q000379:methods*; D018589:Gastroparesis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010185:Pancreatic Fistula / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011708:Pylorus / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome