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

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. © The Author(s) 2026.