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Background: Delayed gastric emptying (DGE) is a major cause of morbidity following pancreaticoduodenectomy(PD), with various factors implicated in its development. The influence of operative technique on the occurrence of DGE is controversial. The impact of a Braun enteroenterostomy (BE) in reconstruction following classic PD was assessed.

Methods: Forty-four consecutive patients undergoing non-pylorus preserving PD from August 2009 to November 2011 by a single surgeon were included in this study. The first twenty patients had a standard antecolic gastrojejunal anastomosis. The subsequent twenty-four patients had an antecolic gastrojejunal anastomosis with the addition of a BE. The groups were compared and complications assessed according to criteria set by the International Study Group of Pancreatic Surgery (ISGPS).

Results: Patient characteristics between the groups were similar as was the extent of surgery and tumour and pancreatic characteristics. The median estimated blood loss was greater in the standard reconstruction group (450 ml (100-1500) vs 325(100-1500 ml) p = 0.04). All other operative factors, including intra-operative blood transfusions were similar between the two groups. The DGE rate in the BE was significantly lower than the standard reconstruction group (1(4%)versus 7(35%); p=0.015). In the standard group, 6 of 7 cases of DGE were Class C in nature. The pancreatic fistula rate in the BE group was similar to the standard reconstruction group (4(21% versus 5(29%); p=0.706) as was the median length of hospital stay (10 days (7-38) vs 15 (7-45); p= 0.291). On assessing factors associated with DGE, the BE technique was the only significant factor in this study.

Conclusion: The use of BE following non-pylorus preserving PD appears to results in a significant reduction in DGE.