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Braun Enteroenterostomy: A Safe Technique to Minimize Risk of Delayed Gastric Emptying After Distal Gastrectomy
Stephen Doane^*, Michael Pucci, Karen Chojnacki, Ernest L. Rosato
Surgery, Thomas Jefferson University Hospital, Philadelphia, PA

Delayed gastric emptying (DGE) can be a significant complication after partial gastric resection for benign or malignant disease. Braun enteroenterostomy was originally designed to prevent afferent loop syndrome after a Billroth II gastrojejunal anastomosis. Adding a Braun anastomosis may also improve gastric emptying and decrease the risk of alkaline reflux gastritis while avoiding the possible dysmotility from Roux stasis syndrome.
We reviewed the outcomes of all distal gastrectomy patients over a 14-year period who received Billroth II reconstruction with a Braun enteroenterostomy (n=34), most of which were performed in patients with malignancy (76%). There was a 9% incidence of delayed gastric emptying, which was defined as more than 10 days until final tolerance of solid food. The median time to tolerance of solid food was 5 days. The median post-operative length of stay was 7 days. Overall 30-day re-admission rate, morbidity, and mortality were 3%, 21%, and 0% respectively. There was no morbidity attributable to the Braun anastomosis.
Braun enteroenterostomy appears to be a valuable technique for accelerating the tolerance of a solid diet after distal gastrectomy and may have a role within enhanced recovery pathways for gastric surgery.

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