Lengthened Efferent Limb in Braun Enteroenterostomy Reduces Delayed Gastric Emptying After Pancreaticoduodenectomy. 2023

Genki Watanabe, and Shouichi Satou, and Motomu Tanaka, and Masashi Momiyama, and Kentaro Nakajima, and Atsuki Nagao, and Hitoshi Satodate, and Tamaki Noie
Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan.

Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PD), but a method to prevent DGE has not been established. This study aims to demonstrate a novel technique utilizing a lengthened efferent limb in Billroth-II (B-II) reconstruction during PD and to evaluate the impact of the longer efferent limb on DGE occurrence. Patients who underwent PD with B-II reconstruction were divided into two groups: PDs with lengthened (50-60 cm) efferent limb (L group) and standard length (0-30 cm) efferent limb (S group). Postoperative outcomes were compared. DGE was defined and graded according to the International Study Group of Pancreatic Surgery criteria. Among 283 consecutive patients who underwent PD from 2002 to 2021, 206 patients were included in this study. Patients who underwent Roux-en-Y reconstruction (n = 77) were excluded. Compared with the S group, the L group included older patients and those who underwent PD after 2016 (p = 0.025, < 0.001, respectively). D2 lymphadenectomy, antecolic route reconstruction, and Braun enteroenterostomy were performed more frequently in the L group (p = 0.040, < 0.001, < 0.001, respectively). The rate of DGE was significantly decreased to 6% in the L group, compared with 16% in the S group (p = 0.027), which might lead to a shorter hospital stay in the L group (p < 0.001). Multivariable analysis identified two factors as independent predictors for DGE: intraabdominal abscess [odds ratio (OR) 5.530, p = 0.008] and standard efferent limb length (OR 2.969, p = 0.047). A lengthened efferent limb in Braun enteroenterostomy could reduce DGE after PD.

UI MeSH Term Description Entries
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D005746 Gastric Emptying The evacuation of food from the stomach into the duodenum. Emptying, Gastric,Emptyings, Gastric,Gastric Emptyings
D005763 Gastroenterostomy A variety of surgical reconstructive procedures devised to restore gastrointestinal continuity, The two major classes of reconstruction are the Billroth I (gastroduodenostomy) and Billroth II (gastrojejunostomy) procedures. Billroth I,Billroth I Operation,Billroth I Procedure,Billroth II,Billroth II Operation,Billroth II Procedure,Gastroenterostomies,Operation, Billroth I,Operation, Billroth II,Procedure, Billroth I,Procedure, Billroth II
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000714 Anastomosis, Surgical Surgical union or shunt between ducts, tubes or vessels. It may be end-to-end, end-to-side, side-to-end, or side-to-side. Surgical Anastomosis,Anastomoses, Surgical,Surgical Anastomoses
D016577 Pancreaticoduodenectomy The excision of the head of the pancreas and the encircling loop of the duodenum to which it is connected. Duodenopancreatectomy,Pancreatoduodenectomy,Duodenopancreatectomies,Pancreaticoduodenectomies,Pancreatoduodenectomies
D018589 Gastroparesis Chronic delayed gastric emptying. Gastroparesis may be caused by motor dysfunction or paralysis of STOMACH muscles or may be associated with other systemic diseases such as DIABETES MELLITUS. Gastric Stasis,Gastric Stases,Gastropareses,Stases, Gastric,Stasis, Gastric

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