Efficacy and safety of Braun enteroenterostomy in patients undergoing pancreatoduodenectomy: a systematic review and meta-analysis

Abstract

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, I 2 = 34%). The rate of reoperation was lower in patients with BEE (OR = 0.35, 95% CI 0.20, 0.64, I 2 = 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, I 2 = 33% and OR = 0.36, 95% CI 0.23, 0.57, I 2 = 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, I 2 = 42% and OR = 0.60, 95% CI 0.41, 0.88, I 2 = 34%). Operative time was higher in patients with BEE (MD = 12.6 min; 95% CI 0.9, 24.3, I 2 = 58%), while hospital stay was shorter (MD = − 3.4 days, 95% CI − 5.6, − 1.1, I 2 = 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.