• Faik G Uzunoglu, Matthias Reeh, Romy Wollstein, Nathaniel Melling, Daniel Perez, Yogesh K Vashist, Dean Bogoevski, Jakob R Izbicki, and Maximilian Bockhorn.
• Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
• World J Surg. 2014 Dec 1;38(12):3228-34.

BackgroundThe aim of this study was to analyze the impact of single Roux-en-Y reconstruction (RYR) and double Roux-en-Y reconstruction (dRYR) on intraoperative outcome and postoperative morbidity and mortality after pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PPPD).MethodsAll patients who underwent surgery between 2000 and 2005 for dRYR and RYR after PD or PPPD at the study hospital were evaluated for inclusion. Comparison of categorical patient characteristics was performed using the χ (2) test. Data were reported as median and range. Differences were analyzed with the Mann-Whitney U test. Postoperative complications were graded according to the Clavien-Dindo classification scheme and the recommendations of the International Study Group of Pancreatic Surgery (ISGPS).ResultsA total of 319 patients were included in final analysis. The median time of surgery was significantly shorter when performing a single Roux-en-Y loop reconstruction (55 min in PD and 50 min in PPPD) (p < 0.001). Saved time had a significant effect on the cost of surgery (p < 0.001). No impact on postoperative outcome according to the Clavien-Dindo classification, the ISGPS definitions of pancreatic fistulas, and delayed gastric emptying was evident. The relaparotomy rate due to severe postoperative hemorrhage was significantly higher in the dRYR PD cohort (2.2 vs. 11.9 %, p < 0.001).ConclusionsDouble Roux-en-Y reconstruction of the alimentary tract is not beneficial in terms of surgical outcome and postoperative morbidity and mortality and should be avoided due to unnecessarily prolonged surgery.

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