Braun Enteroenterostomy Following Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis.
Pancreaticoduodenectomy (PD) holds high postoperative morbidity. How to resolve this issue is challenged. An additional anastomosis (Braun enteroenterostomy) following PD may decrease the postoperative morbidity, but holds conflicting results. The objective of this study is to investigate the advantages and disadvantages of Braun enteroenterostomy in PD.Clinical studies compared perioperative outcomes between the Braun group and the non-Braun group following PD before December 21, 2014 were retrieved and filtered from PubMed, EMBASE, Web of Science, the Cochrane Library, and Chinese electronic databases (VIP database, WanFang database, and CNKI database). Relevant data were extracted according to predesigned sheets. Blood loss, operating time, and postoperative mortality and morbidity were evaluated using odds ratio (OR), weighted mean difference, or standard mean difference (SMD).Ten studies concerning 1614 patients were included. No significant differences between the Braun and the non-Braun group were identified in mortality (OR: 0.65, 95% confidence interval [CI]: 0.26-1.60), intraoperative blood loss (SMD: -0.035, 95% CI: -0.253 to 0.183), postoperative pancreatic fistula (POPF) (OR: 0.67, 95% CI: 0.35-1.67), bile leakage (OR: 0.537, 95% CI: 0.287-1.004), postoperative gastrointestinal hemorrhage (OR: 1.17, 95% CI: 0.578-2.385), intraabdominal abscesses (OR: 0.793, 95% CI: 0.444-1.419), wound complications (OR: 0.806, 95% CI: 0.490-1.325), and hospital stay (SMD: -0.098, 95% CI: -0.23 to 0.033). Braun enteroenterostomy extended operating time (SMD: 0.39, 95% CI: 0.02-0.78), but it was associated with lower reoperation rate (OR: 0.380, 95% CI: 0.149-0.968), lower morbidity rate (OR: 0.66, 95% CI: 0.49-0.91), lower clinically relevant delayed gastric emptying (Grades B and C) (OR: 0.375, 95% CI: 0.164-0.858), lower nasogastric tube reinsertion (OR: 0.436, 95% CI: 0.232-0.818), and less postoperative vomiting (OR: 0.444, 95% CI: 0.262-0.755).Braun enteroenterostomy can be safely performed during PD. It is beneficial for patients and could be recommended in PD from the current published data.PROSPERO registration number: CRD42015016198.
From the Department of General Surgery, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, China (BX, Y-HZ, M-PQ, R-RS); Department of Clinical Laboratory, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang, China (Y-WZ); and Department of Surgical Intensive Care Unit, Zhongshan Hospital, Fudan University, Shanghai, China (W-YZ).
Bin
B
Xu
Ya-Hui
YH
Zhu
Ming-Ping
MP
Qian
Rong-Rong
RR
Shen
Wen-Yan
WY
Zheng
Yong-Wei
YW
Zhang
D000714:Anastomosis, Surgical; D004766:Enterostomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D010185:Pancreatic Fistula / Q000453:epidemiology; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation