title: Single versus double Roux-en-Y reconstruction techniques in pancreaticoduodenectomy: a comparative single-center study.
abstract: BACKGROUND
  The aim of this study was to analyze the impact of single Roux-en-Y reconstruction (RYR) and double Roux-en-Y reconstruction (dRYR) on intraoperative outcome and postoperative morbidity and mortality after pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PPPD).
  
  
  METHODS
  All patients who underwent surgery between 2000 and 2005 for dRYR and RYR after PD or PPPD at the study hospital were evaluated for inclusion. Comparison of categorical patient characteristics was performed using the χ (2) test. Data were reported as median and range. Differences were analyzed with the Mann-Whitney U test. Postoperative complications were graded according to the Clavien-Dindo classification scheme and the recommendations of the International Study Group of Pancreatic Surgery (ISGPS).
  
  
  RESULTS
  A total of 319 patients were included in final analysis. The median time of surgery was significantly shorter when performing a single Roux-en-Y loop reconstruction (55 min in PD and 50 min in PPPD) (p < 0.001). Saved time had a significant effect on the cost of surgery (p < 0.001). No impact on postoperative outcome according to the Clavien-Dindo classification, the ISGPS definitions of pancreatic fistulas, and delayed gastric emptying was evident. The relaparotomy rate due to severe postoperative hemorrhage was significantly higher in the dRYR PD cohort (2.2 vs. 11.9 %, p < 0.001).
  
  
  CONCLUSIONS
  Double Roux-en-Y reconstruction of the alimentary tract is not beneficial in terms of surgical outcome and postoperative morbidity and mortality and should be avoided due to unnecessarily prolonged surgery.
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Faik G
authors.initials: FG
authors.lastname: Uzunoglu
authors.forename: Matthias
authors.initials: M
authors.lastname: Reeh
authors.forename: Romy
authors.initials: R
authors.lastname: Wollstein
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Melling
authors.forename: Daniel
authors.initials: D
authors.lastname: Perez
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Vashist
authors.forename: Dean
authors.initials: D
authors.lastname: Bogoevski
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
authors.forename: Maximilian
authors.initials: M
authors.lastname: Bockhorn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D057868:Anastomotic Leak / Q000209:etiology; D005260:Female; D005746:Gastric Emptying / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D059351:Organ Sparing Treatments; D010185:Pancreatic Fistula / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011708:Pylorus; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors