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Duan P, Sun L, Kou K, Li XR, Zhang P. Surgical techniques to prevent delayed gastric emptying after pancreaticoduodenectomy. Hepatobiliary Pancreat Dis Int 2024; 23:449-457. [PMID: 37980179 DOI: 10.1016/j.hbpd.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 10/31/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Delayed gastric emptying (DGE) is one of the most common complications after pancreaticoduodenectomy (PD). DGE represents impaired gastric motility without significant mechanical obstruction and is associated with an increased length of hospital stay, increased healthcare costs, and a high readmission rate. We reviewed published studies on various technical modifications to reduce the incidence of DGE. DATA SOURCES Studies were identified by searching PubMed for relevant articles published up to December 2022. The following search terms were used: "pancreaticoduodenectomy", "pancreaticojejunostomy", "pancreaticogastrostomy", "gastric emptying", "gastroparesis" and "postoperative complications". The search was limited to English publications. Additional articles were identified by a manual search of references from key articles. RESULTS In recent years, various surgical procedures and techniques have been explored to reduce the incidence of DGE. Pyloric resection, Billroth II reconstruction, Braun's enteroenterostomy, and antecolic reconstruction may be associated with a decreased incidence of DGE, but more high-powered studies are needed in the future. Neither laparoscopic nor robotic surgery has demonstrated superiority in preventing DGE, and the use of staplers is controversial regarding whether they can reduce the incidence of DGE. CONCLUSIONS Despite many innovations in surgical techniques, there is no surgical procedure that is superior to others to reduce DGE. Further larger prospective randomized studies are needed.
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Affiliation(s)
- Peng Duan
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun 130021, China
| | - Lu Sun
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun 130021, China
| | - Kai Kou
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun 130021, China
| | - Xin-Rui Li
- Department of Dental Implantology, Hospital of Stomatology, Jilin University, Changchun 130021, China
| | - Ping Zhang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun 130021, China.
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Martín S, Busquets J, Fabregat J. Which is the best option?: An updated review of the most widely used technical variations in entero-enteric anastomosis to minimise delayed gastric emptying after partial pancreatoduodenectomy. Cir Esp 2023; 101:847-850. [PMID: 36265772 DOI: 10.1016/j.cireng.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 11/05/2022]
Affiliation(s)
- S Martín
- Cirurgia General i Digestiva, Hospital Viladecans, Barcelona 08907, Spain.
| | - J Busquets
- Department of Hepatobiliary and Pancreatic Surgery, Bellvitge University Hospital, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, University of Barcelona L'Hospitalet de Llobregat, Barcelona 08907, Spain.
| | - J Fabregat
- Department of Hepatobiliary and Pancreatic Surgery, Bellvitge University Hospital, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, University of Barcelona L'Hospitalet de Llobregat, Barcelona 08907, Spain
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3
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P A, C K, R P, Chidambaranathan S, O L NB. Marginal Ulcer Perforation in a Whipple Survivor: A Rare Long-Term Complication. Cureus 2022; 14:e28050. [PMID: 36127996 PMCID: PMC9477553 DOI: 10.7759/cureus.28050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/05/2022] Open
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Li XG, Song QY, Wu D, Li S, Zhang BL, Zhang LY, Guan D, Wang XX, Liu L. Does the addition of Braun anastomosis to Billroth II reconstruction on laparoscopic-assisted distal gastrectomy benefit patients? World J Gastrointest Oncol 2022; 14:1141-1147. [PMID: 35949212 PMCID: PMC9244985 DOI: 10.4251/wjgo.v14.i6.1141] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/19/2021] [Accepted: 05/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Operation is the primary therapeutic option for patients with distal gastrectomy. Braun anastomosis is usually performed after Billroth II reconstruction, which is wildly applied on distal gastrectomy because it is believed to benefit patients. However, studies are needed to confirm that. AIM To identify whether the addition of Braun anastomosis to Billroth II reconstruction on laparoscopy-assisted distal gastrectomy benefits patients. METHODS A total of 143 patients with gastric cancer underwent laparoscopy-assisted distal gastrectomy at Centre 1 of PLA general hospital between January 2015 and December 2019. Clinical data of the patients were collected, and 93 of the 143 patients were followed up. These 93 patients were divided into two groups: Group 1 (Billroth II reconstruction, 33 patients); and Group 2 (Billroth II reconstruction combined with Braun anastomosis, 60 patients). Postoperative complication follow-up data and relevant clinical data were compared between the two groups. RESULTS There were no significant differences between Group 1 and Group 2 in postoperative complications (6.1% vs 6.7%, P = 0.679), anal exhaust time or blood loss. The follow-up prevalence of reflux gastritis indicated no significant difference between Group 1 and Group 2 (68.2% vs 51.7%, P = 0.109). The follow-up European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 scores revealed no evident difference between Group 1 and Group 2 as well. Group 1 had a shorter operating time than Group 2 on average (234.6 min vs 262.0 min, P = 0.017). CONCLUSION Combined with Billroth II reconstruction, Braun anastomosis has been applied due to its ability to reduce the prevalence of reflux gastritis. Whereas in this study, the prevalence of reflux gastritis showed no significant difference, leading to a conclusion that under the circumstance of Braun anastomosis costing more time and more money, simple Billroth II reconstruction should be widely applied.
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Affiliation(s)
- Xiong-Guang Li
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Qi-Ying Song
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Di Wu
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Shuo Li
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Ben-Long Zhang
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Li-Yu Zhang
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Da Guan
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Xin-Xin Wang
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Lu Liu
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
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5
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Symptomatic marginal ulcer after pancreatoduodenectomy. Surgery 2020; 168:67-71. [PMID: 32276736 DOI: 10.1016/j.surg.2020.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/02/2020] [Accepted: 02/10/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Marginal ulcer is a well-known complication after pancreatoduodenectomy. In light of increasing long-term survival after pancreatoduodenectomy, the identification of risk factors and preventive strategies are of utmost importance. We assessed the incidence, clinical impact, and potential risk factors of marginal ulcer after pancreatoduodenectomy. METHODS A prospectively maintained database of patients undergoing pancreatoduodenectomy was analyzed retrospectively. Univariate and bivariate competing-risk Cox regression analyses were performed to identify risk factors for marginal ulcer. RESULTS Two hundred and fifty-five consecutive patients underwent pancreatoduodenectomy. The median follow-up was 35.7 months. Marginal ulcer was diagnosed in 19 patients (7.5%), and the median time from pancreatoduodenectomy to marginal ulcer diagnosis was 450 days. Thirteen of these 19 patients presented with abdominal pain, melena, or anemia. In all these 13 patients, marginal ulcer resolved with proton pump inhibitor therapy and endoscopic surveillance. Six patients with marginal ulcer presented with an acute abdomen and underwent emergency laparotomy for marginal ulcer perforation and peritonitis. There was no marginal ulcer-related mortality. Univariate and bivariate competing-risk analyses showed an increased risk for marginal ulcer with discontinuation of proton pump inhibitor therapy, smoking, alcohol intake, and the use of non-steroidal anti-inflammatory drugs. Discontinuation of proton pump inhibitor therapy was an independent risk factor for marginal ulcer development. CONCLUSION Marginal ulcer is a relevant long-term complication after pancreatoduodenectomy that occurs more frequently after proton pump inhibitor therapy is discontinued. Based on our data, permanent use of proton pump inhibitor after pancreatoduodenectomy is strongly recommended especially for those patients who smoke, consume alcohol, or use non-steroidal anti-inflammatory drugs.
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Schorn S, Demir IE, Vogel T, Schirren R, Reim D, Wilhelm D, Friess H, Ceyhan GO. Mortality and postoperative complications after different types of surgical reconstruction following pancreaticoduodenectomy-a systematic review with meta-analysis. Langenbecks Arch Surg 2019; 404:141-157. [PMID: 30820662 DOI: 10.1007/s00423-019-01762-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 02/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pancreaticoduodenectomy/PD is a technically demanding pancreatic resection. Options of surgical reconstruction include (1) the child reconstruction defined as pancreatojejunostomy/PJ followed by hepaticojejunostomy/HJ and the gastrojejunostomy/GJ "the standard/s-Child," (2) the s-child reconstruction with an additional Braun enteroenterostomy "BE-Child," or (3) Isolated-Roux-En-Y-pancreaticojejunostomy "Iso-Roux-En-Y," in which the pancreas anastomosis is reconstructed in a separate loop after the GJ. Yet, the impact of these reconstruction methods on patients' outcome has not been sufficiently compared in a systematic manner. METHODS A systematic review and meta-analysis were conducted according to the Preferred-Reporting-Items-for-Systematic-review-and-Meta-Analysis/PRISMA-guidelines by screening Pubmed/Medline, Scopus, Cochrane Library and Web-of-Science. Articles meeting predefined criteria were extracted and meta-analysis was performed. RESULTS Nineteen studies were identified comparing BE-Child or Isolated-Roux-En-Y vs. s-Child. Compared to s-Child neither BE-Child (p = 0.43) nor Iso-Roux-En-Y (p = 0.94) displayed an impact on postoperative mortality, whereas BE-Child showed less postoperative complications (p = 0.02). BE-Child (p = 0.15) and Iso-Roux-En-Y (p = 0.61) did not affect postoperative pancreatic fistula/POPF in general, but BE-Child was associated with a decrease of clinically relevant POPF (p = 0.005), clinically relevant delayed gastric emptying/DGE B/C (p = 0.004), bile leaks (p = 0.01), and hospital stay (p = 0.06). BE-Child entailed also an increased operation time (p = 0.0002) with no impact on DGE A/B/C, hemorrhage, surgical site infections and pulmonary complications. CONCLUSION BE-Child is associated with a decreased risk for postoperative complications, particularly a decreased risk for clinically relevant DGE, POPF, and bile leaks, whereas Iso-Roux-En-Y does not seem to affect the clinical course after PD. Therefore, BE seems to be a valuable surgical method to improve patients' outcome after PD.
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Affiliation(s)
- Stephan Schorn
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Ihsan Ekin Demir
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Thomas Vogel
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Rebekka Schirren
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniel Reim
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Dirk Wilhelm
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Helmut Friess
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Güralp Onur Ceyhan
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Zhou Y, Hu B, Wei K, Si X. Braun anastomosis lowers the incidence of delayed gastric emptying following pancreaticoduodenectomy: a meta-analysis. BMC Gastroenterol 2018; 18:176. [PMID: 30477442 PMCID: PMC6258435 DOI: 10.1186/s12876-018-0909-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/14/2018] [Indexed: 12/19/2022] Open
Abstract
Background Delayed gastric emptying (DGE) is one of the most frequent complications following pancreaticoduodenectomy. This meta-analysis aimed to evaluate the impact of Braun enteroenterostomy on DGE following pancreaticoduodenectomy. Methods A systematic review of the literature was performed to identify relevant studies. Statistical analysis was carried out using Review Manager software 5.3. Results Eleven studies involving 1672 patients (1005 in Braun group and 667 in non-Braun group) were included in the meta-analysis. Braun enteroenterostomy was associated with a statistically significant reduction in overall DGE (odds ratios [OR] 0.32, 95% confidence intervals [CI] 0.24 to 0.43; P <0.001), clinically significant DGE (OR 0.27, 95% CI 0.15 to 0.51; P <0.001), bile leak (OR 0.50, 95% CI 0.29 to 0.86; P = 0.01), and length of hospital stay (weighted mean difference -1.66, 95% CI -2.95 to 00.37; P = 0.01). Conclusions Braun enteroenterostomy minimizes the rate and severity of DGE following pancreaticoduodenectomy.
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Affiliation(s)
- Yanming Zhou
- Department of Hepatobiliary & Pancreatovascular Surgery, First affiliated Hospital of Xiamen University, Xiamen, China.
| | - Bin Hu
- Department of Clinical Laboratory Medicine, First affiliated Hospital of Xiamen University, Xiamen, China
| | - Kongyuan Wei
- Department of General Surgery, First Hospital of Lanzhou University, Lanzhou, China
| | - Xiaoying Si
- Department of Hepatobiliary & Pancreatovascular Surgery, First affiliated Hospital of Xiamen University, Xiamen, China
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Vanbrugghe C, Campanile M, Caamaño A, Pol B. Management of delayed stenosis of pancreatico-enteric anastomosis following pancreatoduodenectomy. J Visc Surg 2018; 156:30-36. [PMID: 30119964 DOI: 10.1016/j.jviscsurg.2018.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Stenosis of the pancreatico-enteric anastomosis following pancreatoduodenectomy (PD), a late post-operative complication that is seen mainly after PD for diseases with good prognosis, has been reported in less than 3% of cases in the literature. Most often asymptomatic, pancreatic-enteric anastomotic stenosis can lead to pancreatitis, pain or pancreatic insufficiency. Symptomatic stenosis is difficult to treat and its management is not standardized. Magnetic resonance cholangiopancreatography is the best investigation to confirm the diagnosis of stenosis. The Endoscopic UltraSonography (EUS) « rendezvous » technique, associating an endoscopic approach and EUS-guided puncture of the main pancreatic duct, has been available since 2010. Of note, however, the failure rate of the EUS series is as high as 25%, leading to repeat procedures. Surgical reconstruction of the anastomosis has been reported with good results in terms of morbidity. Surgical re-do of the pancreatico-enteric anastomosis for stenosis following PD carries a low risk of pancreatic fistula (around 5%) and an overall morbidity rate of around 20%.
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Affiliation(s)
- C Vanbrugghe
- Service de chirurgie digestive et endocrinienne, hôpital Saint-Joseph-Marseille, 255, avenue du Prado, 13008 Marseille, France.
| | - M Campanile
- Service de chirurgie digestive et endocrinienne, hôpital Saint-Joseph-Marseille, 255, avenue du Prado, 13008 Marseille, France
| | - A Caamaño
- Service de chirurgie digestive et endocrinienne, hôpital Saint-Joseph-Marseille, 255, avenue du Prado, 13008 Marseille, France
| | - B Pol
- Service de chirurgie digestive et endocrinienne, hôpital Saint-Joseph-Marseille, 255, avenue du Prado, 13008 Marseille, France
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9
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Addition of Mesh Reinforcement for Pancreatic Stump and Braun Enteroenterostomy after Pancreaticoduodenectomy: A Single Institution Experience. Am Surg 2018. [DOI: 10.1177/000313481808400320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The morbidity rate after pancreaticoduodenectomy (PD) remains high and a modified digestive reconstruction may affect the postoperative complications. We investigated a new modification of PD by adding mesh reinforcement for the pancreatic stump and Braun enteroenterostomy with the aim of reducing postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE), respectively. From November 2010 to April 2015, 81 consecutive patients who underwent modified PD were retrospectively reviewed. The clinically relevant POPF and DGE rates were 4.9 and 6.1 per cent, respectively. The overall mortality rate was 2.4 per cent. The incidence of overall postoperative complications was 46.9 per cent, with 17.2 per cent considered as major complications (Clavien grades 3–5). The median postoperative length of hospital stay was 17 days (range 10–119 days). For patients who had major complications, median postoperative length of hospital stay increased significantly (22 vs 13 days, P = 0.001), as compared with those patients with no complications. The new modified digestive reconstruction after PD seems safe and reliable with low clinically relevant POPF and DGE rates. Further prospective controlled trials are essential to support these results.
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Kakaei F, Beheshtirouy S, Nejatollahi SMR, Rashidi I, Asvadi T, Habibzadeh A, Oliaei-Motlagh M. Effects of adding Braun jejunojejunostomy to standard Whipple procedure on reduction of afferent loop syndrome - a randomized clinical trial. Can J Surg 2016; 58:383-8. [PMID: 26574829 DOI: 10.1503/cjs.005215] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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. CONCLUSION 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. TRIAL REGISTRATION IRCT2014020316473N1 (www.irct.ir).
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Affiliation(s)
- Farzad Kakaei
- 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)
| | - Samad Beheshtirouy
- 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)
| | - Seyed Moahammad Reza Nejatollahi
- 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)
| | - Iqbal Rashidi
- 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)
| | - Touraj Asvadi
- 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)
| | - Afshin Habibzadeh
- 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)
| | - Mohammad Oliaei-Motlagh
- 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)
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Huang MQ, Li M, Mao JY, Tian BL. Braun enteroenterostomy reduces delayed gastric emptying: A systematic review and meta-analysis. Int J Surg 2015; 23:75-81. [PMID: 26384836 DOI: 10.1016/j.ijsu.2015.09.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/26/2015] [Accepted: 09/07/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND It remains controversial whether the additional Braun enteroenterostomy (BEE) is necessary in decreasing delayed gastric emptying (DGE) following pancreaticoduodenectomy (PD). This meta-analysis aims to assess the efficacy of the additional BEE in reducing DGE after PD. METHODS PubMed, EMBASE, Science Citation Index and The Cochrane Library were searched to identify relevant studies. Articles published before May 15, 2015 comparing BEE with traditional gastrojejunostomy during PD were selected. The evaluated end points consist of intro-operative outcomes as well as postoperative complications. RESULTS Seven observational clinical studies that recruited 1401 patients were included. This meta-analysis indicated that the occurrence of DGE was lower in Braun group (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.15 to 0.60; P = 0.0007). Overall morbidity (OR, 0.61; 95%CI, 0.47 to 0.80; P = 0.0003) and the length of hospital stay (LOS) (weighted mean difference [WMD], -1.80; 95%CI, -3.4 to -0.18; p = 0.03) were also in favor of the Braun group. However, Braun group had no advantage over Non-Braun group in terms of intra-operative blood loss, mortality, pancreatic fistula, bile Leakage and intra-abdominal abscess. CONCLUSION The additional of BEE plays an important role in reducing DGE, overall morbidity and LOS.
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Affiliation(s)
- Ming-quan Huang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Mou Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jing-yu Mao
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Bo-le Tian
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
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Xu B, Zhu YH, Qian MP, Shen RR, Zheng WY, Zhang YW. Braun Enteroenterostomy Following Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2015; 94:e1254. [PMID: 26266356 PMCID: PMC4616697 DOI: 10.1097/md.0000000000001254] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Bin Xu
- 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)
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Chen W, Feng CL, Zhu HT. Effects of different procedures of pancreaticojejunostomy selected based on pancreatic duct diameter and other factors on postoperative recovery. Shijie Huaren Xiaohua Zazhi 2015; 23:1844-1848. [DOI: 10.11569/wcjd.v23.i11.1844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the effects of different procedures of pancreaticojejunostomy selected based on pancreatic duct diameter and other factors on postoperative recovery.
METHODS: A retrospective analysis was performed of the clinical data for 108 patients who underwent pancreaticojejunostomy at the Third Affiliated Hospital of Zunyi Medical College from January 2010 to January 2014. For patients with a pancreatic duct diameter ≥ 3 mm (n = 42), pancreaticojejunostomy was adopted (group A). There were 66 patients with a duct diameter < 3 mm, of whom 28 had a relatively thick pancreatic stump larger than the diameter of the jejunum and received the modified Child pancreaticojejunostomy (group B), and the remaining 38 with a pancreatic stump diameter smaller than the diameter of the jejunum received binding pancreaticojejunostomy (group C). The rate of postoperative complications and clinical efficacy were compared for the two groups.
RESULTS: The pancreatic duct diameter was significantly larger in group A than in groups B and C (P < 0.05), while the pancreatic stump was the largest in group B, significantly larger than the other two groups (P < 0.05). The total time of surgery was not statistically significant among the three groups (P > 0.05). There were nine cases of pancreatic fistula in all of the patients, and the total rate of pancreatic fistula was 8.33%. The rates of postoperative abdominal bleeding, pancreatic fistula, digestive dysfunction, abdominal infection, death, and the average length of stay were not statistically significant among the three groups (P > 0.05).
CONCLUSION: Selection of pancreaticojejunostomy based on the patient's pancreatic duct diameter, jejunum diameter and the diameter of the pancreatic stump is a reasonable way.
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