Braun Anastomosis Benefits
Braun anastomosis is a highly effective surgical technique that prevents bile reflux, reduces marginal ulceration, and decreases reflux esophagitis in patients undergoing gastrojejunostomy or single-anastomosis procedures, with demonstrated efficacy in both bariatric and gastrointestinal surgery contexts. 1
Primary Clinical Benefits
Prevention of Bile Reflux
- Braun anastomosis significantly reduces bile reflux compared to procedures without this modification, with studies showing reduction from 37.5% to 8.3% in single anastomosis sleeve ileal (SASI) bypass patients 2
- In laparoscopic one anastomosis gastric bypass (LOAGB), patients who underwent Braun anastomosis as part of the primary procedure had zero cases of de novo reflux, esophagitis, or anastomotic ulcers, compared to 25% incidence in those without Braun anastomosis 1
- The lateral enteroenterostomy placed distally to the gastrojejunal anastomosis diverts bile away from the gastric remnant, preventing alkaline reflux injury 1
Reduction of Reflux Esophagitis
- Reflux esophagitis incidence decreased from 18.8% to 8.3% when Braun anastomosis was added to SASI bypass procedures 2
- In patients with pre-existing gastroesophageal reflux disease (GERD) or severe esophagitis after laparoscopic sleeve gastrectomy, Braun anastomosis achieved complete resolution of signs and symptoms in 100% of cases (13/13 patients) 1
Management of Marginal Ulceration
- While marginal ulcer rates showed variable results across studies, Braun anastomosis serves as an effective rescue procedure for patients developing postoperative GERD, esophagitis, or esophageal ulcers after primary gastric bypass 1
- The technique prevents the continuous exposure of the gastrojejunal anastomosis to bile and pancreatic secretions, which are key factors in marginal ulcer development 1
Surgical Applications and Indications
Bariatric Surgery Context
- Braun anastomosis should be considered as a primary addition to LOAGB in patients at high risk for reflux complications, including those with pre-existing GERD or history of reflux after sleeve gastrectomy 1
- For SASI bypass procedures, Braun anastomosis addresses the inherent risk of bile reflux associated with single-anastomosis techniques 2
Post-Gastrectomy Reconstruction
- Historically applied after Billroth II reconstruction following distal gastrectomy, though recent evidence shows mixed results regarding reflux gastritis prevention in this specific context 3, 4
- The technique was originally described over 100 years ago as an addition to gastroenterostomy, particularly for patients with inoperable cancer 4
Unresectable Right-Sided Colon Cancer
- For unresectable right-sided colon cancer, side-to-side anastomosis ileotransverse internal bypass represents a valid palliative option when primary resection is not feasible 5
Technical Considerations
Operative Time Trade-off
- Adding Braun anastomosis increases operative time by approximately 27 minutes on average (234.6 min vs 262.0 min in distal gastrectomy cases) 3
- However, this additional time investment is justified by the prevention of complications that would otherwise require reoperation, avoiding multiple procedures and longer hospital stays 1
Safety Profile
- Braun anastomosis does not increase perioperative mortality or short-term postoperative complications compared to procedures without this modification 3
- The technique is technically straightforward and can be performed laparoscopically without significant additional morbidity 1
Clinical Outcomes and Quality of Life
Symptom Resolution
- Complete resolution of reflux symptoms occurs in patients who undergo Braun anastomosis as a secondary procedure for failed primary gastric bypass 1
- Patient satisfaction and quality of life scores show no significant difference between procedures with and without Braun anastomosis, suggesting the technique prevents complications without compromising overall outcomes 3
Long-term Considerations
- Braun anastomosis may reduce the theoretical long-term risk of gastric and esophageal cancer associated with chronic bile reflux, though long-term oncologic data are limited 1
Common Pitfalls and Caveats
Patient Selection
- Braun anastomosis is most beneficial in single-anastomosis procedures where bile reflux risk is inherently higher, rather than as a routine addition to all gastrojejunostomy procedures 2, 1
- Consider patient-specific risk factors including pre-existing GERD, history of reflux complications, and type of primary procedure when deciding whether to add Braun anastomosis 1
Evidence Limitations
- Most available evidence comes from retrospective case series and pilot studies with relatively small sample sizes 2, 3
- Some studies show no significant difference in reflux gastritis rates when Braun anastomosis is added to Billroth II reconstruction, suggesting context-dependent efficacy 3