title: Does modified Braun enteroenterostomy improve alkaline reflux gastritis and marginal ulcer after pancreaticoduodenectomy?
abstract: BACKGROUND
  The safety of pancreaticoduodenectomy has improved significantly. However, alkaline reflux gastritis and marginal ulcer are two substantial problems after pancreaticoduodenectomy.
  
  
  OBJECTIVE
  To identify whether Child reconstruction with a modified Braun enteroenterostomy decreases the incidence of alkaline reflux gastritis and marginal ulcer after pancreaticoduodenectomy better than Roux-en-Y reconstruction.
  
  
  METHODS
  Data on 57 consecutive patients who underwent standard pancreaticoduodenectomy between January 1, 2008 and January 31, 2012 were collected prospectively. Data on early and late complications of the Child reconstruction with a modified Braun enteroenterostomy and Roux-en-Y were gathered. The risk factors of alkaline reflux gastritis and marginal ulcer were also investigated by using univariate and multivariate analyses.
  
  
  RESULTS
  Twenty-five patients received Roux-en-Y and 32 underwent Child reconstruction with a modified Braun enteroenterostomy. Early complications after the two reconstruction methods were insignificant. Significant differences in terms of later postoperative morbidity (P = 0.01) and change in body mass index (P = 0.03) were found 12 months after pancreaticoduodenectomy. No significant difference for alkaline reflux gastritis was observed between the two methods (14.8 vs. 28.6 %, P = 0.24). Marginal ulcer occurred significantly lower in patients with the modified reconstruction than in those with Roux-en-Y reconstruction (11.1 vs. 47.6 %, P = 0.01). Peptic ulcer history, diabetes mellitus, and reconstruction type had a significant effect on marginal ulcer formation.
  
  
  CONCLUSIONS
  Child reconstruction with a modified Braun enteroenterostomy offers an advantage with respect to marginal ulcer after standard pancreaticoduodenectomy, potentially decreasing the incidence of alkaline reflux gastritis as effectively as Roux-en-Y reconstruction.
authors.affiliation: Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
authors.forename: An-Ping
authors.initials: AP
authors.lastname: Su
authors.forename: Neng-Wen
authors.initials: NW
authors.lastname: Ke
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Wei-Guo
authors.initials: WG
authors.lastname: Wang
authors.forename: Zhao-Da
authors.initials: ZD
authors.lastname: Zhang
authors.forename: Xu-Bao
authors.initials: XB
authors.lastname: Liu
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Hu
authors.forename: Bo-Le
authors.initials: BL
authors.lastname: Tian
mesh_terms: D004381:Duodenal Ulcer / Q000209:etiology* / Q000473:pathology; D004766:Enterostomy / Q000379:methods*; D005260:Female; D005756:Gastritis / Q000517:prevention & control*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*
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