- Design
- Systematic review and meta-analysis, 17 studies including 4 RCTs
- Population
- 2731 adults undergoing pancreatoduodenectomy
- Primary outcome
- Delayed gastric emptying, pancreatic fistula, morbidity
- Effect
- DGE grade B/C OR 0.36 (0.23 to 0.57); POPF B/C OR 0.60 (0.41 to 0.88); no difference in RCTs
This meta-analysis pooled 17 studies of 2731 patients undergoing pancreatoduodenectomy, comparing reconstruction with and without a Braun enteroenterostomy. Across all studies, Braun was associated with less clinically relevant delayed gastric emptying (OR 0.36, 95% CI 0.23 to 0.57), fewer clinically relevant pancreatic fistulas (OR 0.60, 0.41 to 0.88), fewer reoperations (OR 0.35) and a hospital stay about 3.4 days shorter, at the cost of about 12.6 minutes more operating time.
The four randomised trials (262 patients), analysed separately, showed no significant difference in any of these outcomes. When randomised evidence disagrees with observational evidence, the randomised evidence generally deserves more weight, even when small.
Braun enteroenterostomy is safe and quick, and remains a reasonable surgeon preference. But the claim that it reduces fistula or delayed emptying is not yet supported by trial data.
- Braun enteroenterostomy adds about 13 minutes and appears safe
- Do not expect it to prevent pancreatic fistula; the randomised trials showed no effect
- Its main plausible benefit is on delayed gastric emptying, still unproven in trials
- Keep standard delayed-emptying measures — early nasogastric removal and prokinetics — regardless
Why it matters
The observational benefit is large enough to tempt adoption; the trial data say not yet.
Don't overread it
The fistula and emptying benefits come from observational studies and disappeared in the four RCTs.
The statistics, in plain English
Observational studies compare surgeons and eras as well as techniques, which can inflate benefit. The RCT subgroup is small (262 patients), so it may have missed a modest effect — but it did not confirm one.
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