Yildiray Daduk, Sabri Ozdas
BMSL reconstruction was associated with lower DGE rates and a shorter hospital stay. No significant difference was observed between the groups' CR-POPF rates. The POPF-related findings should therefore be interpreted with care due to the low event rate and absence of any Grade C cases.
BACKGROUND: The optimal reconstruction technique following pancreaticoduodenectomy (PD) remains a subject of debate. The objective of this study was to compare the clinical effects of isolated Roux-en-Y and Braun modified single loop (BMSL) reconstruction techniques following PD on delayed gastric emptying (DGE), postoperative pancreatic fistula (POPF), length of hospital stay, and other postoperative outcomes.
METHODS: Two hundred thirteen patients who underwent standard open PD (with distal gastrectomy) for periampullary or pancreatic head adenocarcinoma between 2018 and 2025 were analyzed retrospectively. These were categorized into isolated Roux-en-Y (n = 100) and BMSL (n = 113) groups. Risk factors were identified using univariate analysis and Firth's penalized logistic regression to account for rare event bias.
RESULTS: The incidence of clinically relevant (CR-POPF, Grade B) was higher in the Roux-en-Y group than in the BMSL group (7% vs. 1.7%), although the difference was not statistically significant (p = 0,072). However, isolated biochemical leak rates were similar (12% vs. 8%; p = 0.322). In contrast, a significantly lower incidence of DGE was observed in the BMSL group (p = 0.032), together with a shorter mean postoperative hospital stay (10.1 ± 2.3 vs. 11.25 ± 2.7 days; p < 0.001). Firth's penalized logistic regression analysis identified diabetes mellitus and a prolonged operative time as independently associated with the development of both POPF and DGE (p < 0.05). Additionally, diabetes mellitus was independently correlated with DGE development in the BMSL group (OR: 20.75, 95% CI: 5.86-73.44; p < 0.000003). However, this finding requires cautious interpretation due to the wide confidence interval. Low serum albumin levels were independently associated with the development of POPF (p < 0.01).
CONCLUSIONS: BMSL reconstruction was associated with lower DGE rates and a shorter hospital stay. No significant difference was observed between the groups' CR-POPF rates. The POPF-related findings should therefore be interpreted with care due to the low event rate and absence of any Grade C cases.