EVALUATION OF RESULTS OF ERAS PROGRAM AFTER PANCREATODUODENECTOMY DEPENDING ON THE TYPE OF GASTROINTESTINAL RECONSTRUCTION

Abstract

The aim: To assess the effect of gastrojejunostomy with Braun anastomosis during PD for prevention of DGE in ERAS protocol patients. Materials and methods: A total of 92 patients from 28 to 75 years were included in this study, who underwent PD with ERAS program. Patients were divided into 2 groups, depending on type of reconstruction - PD with Child reconstruction and PD with gastrojejunostomy with Braun anastomosis. Results: In non-Braun group nasogastric tube was removed on POD 1 in 56 (93.3%) patients and was reinserted later in 4 (6.7%) patients. DGE was observed in 8 (13,3%) patients, which required enteral feeding via nasojejunal tube. In 51 (85.0%) patients feeding was started according to ERAS program without the need for other methods of nutritional support. In Braun group nasogastric tube was removed on POD 1 in all patients after the X-ray control and oral feeding was started. Due to the development of DGE, a nasojejunal tube for enteral nutrition was placed in two cases. In 30 (93,7%) patients peroral feeding was started in accordance to enhanced recovery program. Thus, the frequency of DGE in group II was lower (6.3%), but the difference did not reach statistical significance (p = 0.299). Conclusions: The formation of a Braun anastomosis in PD with the use of ERAS program can reduce the frequency of DGE and eliminate the consequences of technical errors. More studies are needed for stronger evidence.