Efficacy and safety of Braun enteroenterostomy in patients undergoing pancreatoduodenectomy: a systematic review and meta-analysis
In brief
Braun enteroenterostomy linked to 61% lower odds of delayed gastric emptying
Across 17 studies of pancreaticoduodenectomy, patients receiving Braun enteroenterostomy had lower odds of delayed gastric emptying and pancreatic fistula, and fewer reoperations, but their operations took about 13 minutes longer. Serious complications were similar; importantly, results were not significant in the subgroup of four randomized trials, so whether the procedure itself drives these benefits remains uncertain.
- Journal
- Surgical endoscopy (Q1)
- Published
- 23 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Marios Alogakos, Ahmed Ghani, Stefan Bitar, Georgia Angeliniades, Konstantinos Manousidis, May Y Hajeir, et al.
- PMID
- 42778781
- DOI
- 10.1007/s00464-026-13370-8
Why clinicians should know about it
- Picked for Surgery (paper of the day, 27 September 2026): Braun enteroenterostomy meta-analysis shows lower DGE and POPF after PD
- Picked for Breast and Endocrine Surgery (top studies of the week, 27 September 2026): High-quality evidence in a top journal
Abstract
BACKGROUND: Delayed gastric emptying (DGE) is a common complication after pancreatoduodenectomy (PD). Braun enteroenterostomy (BEE) has been proposed as an adjunct to reduce DGE. This meta-analysis aims to evaluate the safety and efficacy of BEE in patients undergoing PD. METHODS: CINAHL, PubMed, Embase, Scopus, Web of Science, and Cochrane were searched from inception until November 2025. The pooled mean and proportions were analyzed using a random-effects model. This review was prospectively registered with PROSPERO (CRD420251160291). RESULTS: Seventeen studies comprising 2731 patients were included, consisting of 1407 (51.5%) patients with BEE and 1324 (48.5%) without BEE. Serious morbidity was similar between groups (OR = 0.66, 95% CI 0.36, 1.19, I2 = 34%). The rate of reoperation was lower in patients with BEE (OR = 0.35, 95% CI 0.20, 0.64, I2 = 0%). The rates of overall and clinically relevant DGE (Grades B+C) were lower in patients with BEE (OR = 0.39, 95% CI 0.28, 0.54, I2 = 33% and OR = 0.36, 95% CI 0.23, 0.57, I2 = 45%). Similarly, the rates of overall and clinically relevant (Grades B+C) postoperative pancreatic fistula (POPF) were lower in patients with BEE (OR = 0.68, 95% CI 0.49, 0.94, I2 = 42% and OR = 0.60, 95% CI 0.41, 0.88, I2 = 34%). Operative time was higher in patients with BEE (MD = 12.6 min; 95% CI 0.9, 24.3, I2 = 58%), while hospital stay was shorter (MD = - 3.4 days, 95% CI - 5.6, - 1.1, I2 = 75%). On subgroup analysis including four randomized controlled trials (RCT) (262 patients), no significant difference was observed between groups for any of the above outcomes. CONCLUSIONS: BEE appears to be a safe and effective adjunct in selected adult patients undergoing PD. Despite a higher operative time, BEE was associated with a decreased rate of DGE and POPF. However, these findings were not confirmed in a subgroup analysis of four RCTs and should therefore be interpreted with caution. Further randomized prospective studies are required to assess the causative effect of BEE and confirm these promising findings.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.