title: Does Braun Anastomosis Have an Impact on the Incidence of Delayed Gastric Emptying and the Extent of Intragastric Bile Reflux Following Pancreatoduodenectomy? - A Randomized Controlled Study.
abstract: OBJECTIVE
  This study investigated the impact of Braun anastomosis on the incidence of delayed gastric emptying (DGE) and on the intragastric bile reflux after pancreatoduodenectomy with Child reconstruction.
  
  
  METHODS
  Sixty-eight patients who underwent subtotal stomach-preserving pancreatoduodenectomy were included. Patients were randomly assigned to a group with or without Braun anastomosis intraoperatively. Twenty-four-hour intragastric bilirubin monitoring was performed to investigate the extent of intragastric bile reflux after surgery. The incidence of DGE and other complications was also monitored.
  
  
  RESULTS
  There were no differences between the non-Braun and Braun groups in terms of patient characteristics. The incidence rate of DGE was 29.4% (n = 10/34) in the non-Braun group and 20.6% (n = 7/34) in the Braun group (p = 0.401). Forty-six of the 68 patients consented to intragastric bilirubin monitoring. The fraction time of intragastric bilirubin reflux was comparable between the 2 groups. Although the fraction time of intragastric bilirubin reflux had no impact on the incidence of DGE, the incidence of pancreatic fistula was significantly higher in patients with DGE than those without DGE (47.1 vs. 21.6%, p = 0.043).
  
  
  CONCLUSIONS
  The addition of Braun anastomosis after pancreatoduodenectomy did not effectively reduce the intragastric bile reflux and had minor impact in reducing the incidence of DGE.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Fujieda
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hirata
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Usui
authors.forename: Yayoi
authors.initials: Y
authors.lastname: Sakatoku
authors.forename: Masahide
authors.initials: M
authors.lastname: Fukaya
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001655:Bile Reflux / Q000209:etiology*; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010183:Pancreatic Ducts / Q000473:pathology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D013997:Time Factors
keywords: Intragastric bile reflux; Pancreatic fistula; Twenty-four-hour intragastric bilirubin monitoring