title: Effects of adding Braun jejunojejunostomy to standard Whipple procedure on reduction of afferent loop syndrome - a randomized clinical trial.
abstract: BACKGROUND
  Whipple surgery (pancreaticodeudenectomy) has a high complication rate. We aimed to evaluate whether adding Braun jejunojejunostomy (side-to-side anastomosis of afferent and efferent loops distal to the gastrojejunostomy site) to a standard Whipple procedure would reduce postoperative complications.
  
  
  METHODS
  We conducted a randomized clinical trial comparing patients who underwent standard Whipple surgery (standard group) and patients who underwent standard Whipple surgery with Braun jejunojejunostomy (Braun group). Patients were followed for 1 month after the procedure and postoperative complications were recorded.
  
  
  RESULTS
  Our study included 30 patients: 15 in the Braun and 15 in the standard group. In the Braun group, 4 (26.7%) patients experienced 6 complications, whereas in the standard group, 7 (46.7%) patients experienced 11 complications (p = 0.14). Complications in the Braun group were gastrointestinal bleeding and wound infection (n = 1 each) and delayed gastric emptying and pulmonary infection (n = 2 each). Complications in the standard group were death, pancreatic anastomosis leak and biliary anastomosis leak (n = 1 each); gastrointestinal bleeding (n = 2); and afferent loop syndrome and delayed gastric emptying (n = 3 each). There was no significant difference between groups in the subtypes of complications.
  
  
  CONCLUSIONS
  Our results showed that adding Braun jejunojejunostomy to standard Whipple procedure was associated with lower rates of afferent loop syndrome and delayed gastric emptying. However, more studies are needed to define the role of Braun jejunojejunostomy in this regard.
  
  
  BACKGROUND
  IRCT2014020316473N1 (www.irct.ir).
authors.affiliation: From the Department of Surgery, Tabriz University of medical sciences, Imam Reza Hospital, Tabriz, Iran (Kakaei, Beheshtirouy, Rashidi, Asvadi, Habibzadeh, Oliaei-Motlagh); and the Department of Surgery, Shahid Beheshti University of Medical Sciences, Ayatollah Taleghani Hospital, Evin, Tehran, Iran (Nejatollahi).
authors.forename: Farzad
authors.initials: F
authors.lastname: Kakaei
authors.affiliation: From the Department of Surgery, Tabriz University of medical sciences, Imam Reza Hospital, Tabriz, Iran (Kakaei, Beheshtirouy, Rashidi, Asvadi, Habibzadeh, Oliaei-Motlagh); and the Department of Surgery, Shahid Beheshti University of Medical Sciences, Ayatollah Taleghani Hospital, Evin, Tehran, Iran (Nejatollahi).
authors.forename: Samad
authors.initials: S
authors.lastname: Beheshtirouy
authors.affiliation: From the Department of Surgery, Tabriz University of medical sciences, Imam Reza Hospital, Tabriz, Iran (Kakaei, Beheshtirouy, Rashidi, Asvadi, Habibzadeh, Oliaei-Motlagh); and the Department of Surgery, Shahid Beheshti University of Medical Sciences, Ayatollah Taleghani Hospital, Evin, Tehran, Iran (Nejatollahi).
authors.forename: Seyed Moahammad Reza
authors.initials: SM
authors.lastname: Nejatollahi
authors.affiliation: From the Department of Surgery, Tabriz University of medical sciences, Imam Reza Hospital, Tabriz, Iran (Kakaei, Beheshtirouy, Rashidi, Asvadi, Habibzadeh, Oliaei-Motlagh); and the Department of Surgery, Shahid Beheshti University of Medical Sciences, Ayatollah Taleghani Hospital, Evin, Tehran, Iran (Nejatollahi).
authors.forename: Iqbal
authors.initials: I
authors.lastname: Rashidi
authors.affiliation: From the Department of Surgery, Tabriz University of medical sciences, Imam Reza Hospital, Tabriz, Iran (Kakaei, Beheshtirouy, Rashidi, Asvadi, Habibzadeh, Oliaei-Motlagh); and the Department of Surgery, Shahid Beheshti University of Medical Sciences, Ayatollah Taleghani Hospital, Evin, Tehran, Iran (Nejatollahi).
authors.forename: Touraj
authors.initials: T
authors.lastname: Asvadi
authors.affiliation: From the Department of Surgery, Tabriz University of medical sciences, Imam Reza Hospital, Tabriz, Iran (Kakaei, Beheshtirouy, Rashidi, Asvadi, Habibzadeh, Oliaei-Motlagh); and the Department of Surgery, Shahid Beheshti University of Medical Sciences, Ayatollah Taleghani Hospital, Evin, Tehran, Iran (Nejatollahi).
authors.forename: Afshin
authors.initials: A
authors.lastname: Habibzadeh
authors.affiliation: From the Department of Surgery, Tabriz University of medical sciences, Imam Reza Hospital, Tabriz, Iran (Kakaei, Beheshtirouy, Rashidi, Asvadi, Habibzadeh, Oliaei-Motlagh); and the Department of Surgery, Shahid Beheshti University of Medical Sciences, Ayatollah Taleghani Hospital, Evin, Tehran, Iran (Nejatollahi).
authors.forename: Mohammad
authors.initials: M
authors.lastname: Oliaei-Motlagh
mesh_terms: D000293:Adolescent; D000328:Adult; D000343:Afferent Loop Syndrome / Q000209:etiology / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D055815:Young Adult