Braun Enteroenterostomy Research Articles

Endoscopic Braun enteroenterostomy for the management of severe bile acid reflux following Whipple surgery

Endoscopic Braun enteroenterostomy for the management of severe bile acid reflux following Whipple surgery

Analysis of early postoperative outcomes after pancreatoduodenectomy with Braun entero-enteroanastomosis

Objective. To evaluate early postoperative results after pancreatoduodenectomy with Brown entero–enteroanastomosis.
 Materials and methods. Collected data of 162 patients who underwent pancreatoduodenectomy from 2015 to 2023. Group 1 was formed retrospectively and contained patients without Braun entero–enterostomy. Prospectivile formed Group 2 contained patients with Braun entero–enterostomy. The comparative analysis of 2 groups was performed.
 Results. The overall incidence of delayed gastric emptying in both groups was 9.4%. At the same time, the frequency of delayed gastric emptying in the group 2 was significantly lower – 5.9% versus 15% in group 1, although the difference did not reach statistical significance (p=0.896).
 Conclusion. Braun entero–enteroanastomosis during pancreatoduodenectomy reduced the frequency of delayed emptying, while not increasing the number of other complications.

Lengthened Efferent Limb in Braun Enteroenterostomy Reduces Delayed Gastric Emptying After Pancreaticoduodenectomy.

Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PD), but a method to prevent DGE has not been established. This study aims to demonstrate a novel technique utilizing a lengthened efferent limb in Billroth-II (B-II) reconstruction during PD and to evaluate the impact of the longer efferent limb on DGE occurrence. Patients who underwent PD with B-II reconstruction were divided into two groups: PDs with lengthened (50-60cm) efferent limb (L group) and standard length (0-30cm) efferent limb (S group). Postoperative outcomes were compared. DGE was defined and graded according to the International Study Group of Pancreatic Surgery criteria. Among 283 consecutive patients who underwent PD from 2002 to 2021, 206 patients were included in this study. Patients who underwent Roux-en-Y reconstruction (n = 77) were excluded. Compared with the S group, the L group included older patients and those who underwent PD after 2016 (p = 0.025, < 0.001, respectively). D2 lymphadenectomy, antecolic route reconstruction, and Braun enteroenterostomy were performed more frequently in the L group (p = 0.040, < 0.001, < 0.001, respectively). The rate of DGE was significantly decreased to 6% in the L group, compared with 16% in the S group (p = 0.027), which might lead to a shorter hospital stay in the L group (p < 0.001). Multivariable analysis identified two factors as independent predictors for DGE: intraabdominal abscess [odds ratio (OR) 5.530, p = 0.008] and standard efferent limb length (OR 2.969, p = 0.047). A lengthened efferent limb in Braun enteroenterostomy could reduce DGE after PD.

Prospective multicentre randomised controlled trial of the effect of Braun Enteroenterostomy in the Reconstruction after Pancreaticoduodenectomy on delayed gastric emptying (DGE): protocol for the BERP study

IntroductionDespite advances in achieving low mortality rates with pancreaticoduodenectomy (PD), morbidity remains high. A key contributor to this morbidity is delayed gastric emptying (DGE) occurring with an incidence of up...

A Single-site Interventional Study on the Contemporary Relevance of Braun Enteroenterostomy After Pancreaticoduodenectomy

Braun enteroenterostomy following pancreaticoduodenectomy is a standard procedure. It has been reported to decrease bile reflux and vomiting, prevent reflux gastritis and delay gastric emptying (DGE). However, some reports suggest that the incidence of DGE is unaffected with this procedure. Therefore, in this study, we aimed to investigate whether Braun enteroenterostomy was effective after pancreaticoduodenectomy. A total of 145 patients who underwent pancreaticoduodenectomy were enrolled and divided into 2 groups i.e., 51 patients with Braun enteroenterostomy (B group) and 94 patients without Braun enteroenterostomy (non-B group). We compared the perioperative data of the patients. Patients who reported postoperative symptoms underwent gastrointestinal endoscopic evaluation. The incidence of DGE was 7.4% (7/94) and 1.9% (1/51) in the non-B and B groups, respectively (p=0.36), with no significant difference between the groups. During follow-up, some patients reported symptoms including epigastralgia, nausea and melena. The incidence of these symptoms was 27.7% (26 patients; 26/94) and 23.5% (12 patients; 12/51) in non-B and B groups, respectively. Regarding gastrointestinal endoscopic findings, the incidence of anastomotic ulcer was 7.7% (2/26) and 16.7% (2/12) in non-B and B groups, respectively (p=0.40). Bile reflux incidence was 30.8% (8/26) and 0% (0/12) in non-B and B groups, respectively (p=0.03). Though Braun enteroenterostomy was related to bile reflux, it did not affect the incidence of anastomotic and gastric ulcers or DGE. Therefore, it may not be a necessary procedure after pancreaticoduodenectomy.

A Network Meta-Analysis Comparing Gastric Resection Approaches and Enteric Anastomotic Configurations on Delayed Gastric Emptying Following Pancreaticoduodenectomy

Introduction: Delayed gastric emptying (DGE) is frequent following pancreaticoduodenectomy (PD). Several randomized controlled trials (RCTs) have explored operative strategies to minimize DGE, however, the optimal combination of gastric resection approach, anastomotic route, configuration and the use of enteroenterostomy remains unclear. Method: MEDLINE, Embase, and CENTRAL databases were systematically searched for RCTs comparing gastric resection (classic Whipple, pylorus-resecting, pylorus-preserving), anastomotic route (antecolic, retrocolic), configuration (loop gastroenterostomy/Billroth II, Roux-en-Y), and use of Braun enteroenterostomy. A random-effects, Bayesian network meta-analysis with non-informative priors was conducted to determine the optimal combination of approaches to PD for minimizing DGE. Results: A total of 24 RCTs, including 2526 patients and 14 approaches to PD were included. There was some heterogeneity, although inconsistency was low. The overall incidence of DGE was 25.6%. Pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy (Figure 1) was associated with the lowest rates of DGE, and ranked the best in 35% of comparisons. Classic Whipple, retrocolic, Billroth II with Braun enteroenterostomy ranked the worst for DGE, in 32% of comparisons. Pairwise meta-analysis of retrocolic versus antecolic route for gastrojejunostomy found increased risk of DGE with the retrocolic route (OR 2.10, 95% CrI: 0.92-4.70). Pairwise meta-analysis of enteroenterostomy found a trend towards lower DGE rates when a Braun enteroenterostomy was used (OR 1.90, 95% CrI: 0.92-3.90). Conclusions: Based on existing RCT evidence, a pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy seems to be associated with the lowest rates of DGE.

A Simple Trick to Reduce Delayed Gastric Emptying after Pancreaticoduodenectomy

Introduction: Delayed Gastric Emptying (DGE) remains one of unsolved complications after pancreaticoduodenectomy (PD). After 2016, we adapted the long efferent loop (50–60cm) of Braun enteroenterostomy when the reconstruction after PD using the modified Child technique. This study aimed to examine whether the long efferent loop of Braun enteroenterostomy could reduce DGE after PD.

P-P01 Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis

Abstract Background Delayed gastric emptying (DGE) is frequent after pancreaticoduodenectomy (PD). Several randomised controlled trials (RCTs) have explored operative strategies to minimise DGE, however, the optimal combination of gastric resection approach, anastomotic route, and configuration, role of Braun enteroenterostomy remains unclear. Methods MEDLINE, Embase, and CENTRAL databases were systematically searched for RCTs comparing gastric resection (Classic Whipple, pylorus-resecting, and pylorus-preserving), anastomotic route (antecolic vs retrocolic) and configuration (Billroth II vs Roux-en-Y), and enteroenterostomy (Braun vs no Braun). A random-effects, Bayesian network meta-analysis with non-informative priors was conducted to determine the optimal combination of approaches to PD for minimising DGE. Results Twenty-four RCTs, including 2526 patients and 14 approaches were included. There was some heterogeneity, although inconsistency was low. The overall incidence of DGE was 25.6% (n = 647). Pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy was associated with the lowest rates of DGE and ranked the best in 35% of comparisons. Classic Whipple, retrocolic, Billroth II with Braun ranked the worst for DGE in 32% of comparisons. Pairwise meta-analysis of retrocolic vs antecolic route of gastro-jejunostomy found increased risk of DGE with the retrocolic route (OR 2.1, 95% CrI; 0.92 - 4.7). Pairwise meta-analysis of Braun enteroenterostomy found a trend towards lower DGE rates with Braun compared to no Braun (OR 1.9, 95% CrI; 0.92 - 3.9). Having a Braun enteroenterostomy ranked the best in 96% of comparisons. Conclusions Based on existing RCT evidence, a pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy may be associated with the lowest rates of DGE.

Diagnosis and Management of Benign Gastric and Duodenal Disease

The diagnosis of uncomplicated peptic ulcers is difficult to make on a solely clinical basis. Whereas radiographic upper gastrointestinal (UGI) series remain useful, endoscopy is the most accurate method of establishing the diagnosis of peptic ulcer disease. Laboratory tests play an important role in the diagnosis of Helicobacter pylori infection and Zollinger-Ellison syndrome. Figures showing UGI series with double contrast and H. pylori organisms on gastric biopsy samples are provided. The improved medical management of peptic ulcer disease has decreased the need for surgical intervention, which is now largely reserved for urgent management of complications such as hemorrhage, bleeding, and perforation, or the management of obstruction from intractable disease. The appropriate extent of preoperative evaluation for a patient undergoing surgery for a benign gastroduodenal disorder is dictated primarily by the nature of the presenting problem. Endoscopy is the main diagnostic tool to identify the source of bleeding, and in many cases endoscopic therapy can control the bleeding. Angiographic transarterial embolization may be considered following failed endoscopic hemostasis, particularly in high-risk surgical patients. Operative planning is described. The steps of the operative technique, complications, and outcome evaluations are provided for the main surgical interventions for peptic ulcer disease, including vagotomy and pyloroplasty for bleeding duodenal ulcer; resection of bleeding gastric ulcer; omental patch for duodenal perforation (Graham patch); antrectomy; highly selective vagotomy; laparoscopic treatment of peptic ulcer disease; and duodenal diverticulectomy. Operative figures show a Kocher maneuver; omental patch; truncal vagotomy; highly selective vagotomy; Taylor procedure; Heineke-Mikulicz pyloroplasty; Finney pyloroplasty; Billroth I and II antrectomy; Braun enteroenterostomy; and duodenal diverticulectomy. This review contains 15 figures, 2 tables, and 43 references.

Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials.

IntroductionDelayed gastric emptying (DGE) is frequent after pancreaticoduodenectomy (PD). Several RCTs have explored operative strategies to minimize DGE, however, the optimal combination of gastric resection approach, anastomotic route, configuration and the use of enteroenterostomy remains unclear.MethodsMEDLINE, Embase and CENTRAL databases were systematically searched for RCTs comparing gastric resection (classic Whipple, pylorus-resecting, pylorus-preserving), anastomotic route (antecolic, retrocolic), configuration (loop gastroenterostomy/Billroth II, Roux-en-Y), and use of enteroenterostomy (Braun). A random-effects, Bayesian network meta-analysis with non-informative priors was conducted to determine the optimal combination of approaches to PD for minimizing DGE.ResultsTwenty-four RCTs, including 2526 patients and 14 approaches were included. There was some heterogeneity, although inconsistency was low. The overall incidence of DGE was 25.6 per cent (647 patients). Pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy was associated with the lowest rates of DGE and ranked the best in 35 per cent of comparisons. Classic Whipple, retrocolic, Billroth II with Braun ranked the worst for DGE in 32 per cent of comparisons. Pairwise meta-analysis of retrocolic versus antecolic route for gastrojejunostomy found increased risk of DGE with the retrocolic route (odds ratio 2.10, 95 per cent credibility interval (cr.i.) 0.92 to 4.70). Pairwise meta-analysis of enteroenterostomy found a trend towards lower DGE rates when this was used (odds ratio 1.90, 95 per cent cr.i. 0.92 to 3.90). Having a Braun enteroenterostomy ranked the best in 96 per cent of comparisons.ConclusionBased on existing RCT evidence, a pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy seems to be associated with the lowest rates of DGE.PreregistrationPROSPERO submitted 23 December 2020. CRD42021227637

Impact of Gastric Resection and Enteric Anastomotic Configuration on Delayed Gastric Emptying after Pancreaticoduodenectomy: A Network Meta-analysis of Randomized Trials

Purpose: Delayed gastric emptying (DGE) is frequent after pancreaticoduodenectomy (PD). Several randomised controlled trials (RCTs) have explored operative strategies to minimise DGE, however, the optimal combination of gastric resection approach, anastomotic route, and configuration, role of Braun enteroenterostomy remains unclear. Methods: MEDLINE, Embase, and CENTRAL databases were systematically searched for RCTs comparing gastric resection (Classic Whipple, pylorus-resecting, and pylorus-preserving), anastomotic route (antecolic vs retrocolic) and configuration (Billroth II vs Roux-en-Y), and enteroenterostomy (Braun vs no Braun). A random-effects Bayesian network meta-analysis was conducted to determine the optimal combination of approaches to PD for minimising DGE. Results: Twenty-four RCTs, including 2526 patients and 14 approaches were included. There was some heterogeneity, although inconsistency was low. The overall incidence of DGE was 25.6% (n = 647). Pylorus-resecting, antecolic, Billroth II with Braun was associated with the lowest rates of DGE and ranked the best in 35% of comparisons. Classic Whipple, retrocolic, Billroth II with Braun ranked the worst for DGE in 32% of comparisons. Pairwise meta-analysis of retrocolic vs antecolic route of gastro-jejunostomy found increased risk of DGE with the retrocolic route (OR 2.1, 95% CrI; 0.92 - 4.7). Pairwise meta-analysis of Braun found a trend towards lower DGE rates with Braun compared to no Braun (OR 1.9, 95% CrI; 0.92 - 3.9). Having a Braun ranked the best in 96% of comparisons. Conclusion: Based on existing RCT evidence, a pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy may be associated with the lowest rates of DGE.

Braun anastomosis may reduce the incidence of delayed gastric emptying following pancreaticoduodenectomy, but does not shorten the length of hospital stay

Introduction:: Delayed gastric emptying (DGE) is one of the most frequent complications following pancreaticoduodenectomy (PD). The preventive effect of Braun enteroenterostomy on DGE is still controversial. We examined the association between addition of a Braun anastomosis and the incidence and severity of DGE, the length of stay (LOS) and postoperative morbidity. Methods: A retrospective analysis of a prospectively collected database including all patients undergoing elective open PD by a single attending surgeon (January 2016 - June 2018). Reconstruction was based on a “classic” loop with an ante colic side to side gastroenterostomy. Braun was done in the second half of the cohort. The majority of patients were managed according to enhanced recovery protocol (ERAS). Using the ISGPS 2007 definition and classification of DGE, a univariate analysis was performed to evaluate the impact of adding a Braun enteroenterostomy, on the incidence of DGE, LOS and post-operative morbidity. Results: 82 patients were included (41 females and 41 males, mean age 65y, range 17-85), 35 with a Braun anastomosis vs. 47 without. Both groups are comparable with regard to demographic and clinical characteristics. Overall, 25 (30.5%) patients suffered from DGE, with 6 (7.3%) having grade C DGE. Only 1/35 (2.9%) of patients with Braun had grade C DGE, as opposed to 5/47 (10.6%) among the patients without a Braun. This difference did not reach statistical significance (p=0.36). The mean length of stay (LOS) was 17 days in both the Braun and non-Braun group, (range 8-53 and 6-95 respectively). 10/47 (21.2%) of patients in the non-Braun group suffered from at least one severe postoperative complication (Clavien Dindo ≥3) compared to 6/35 (17.1%) in the Braun group (p=0.62). Conclusion: Adding Braun anastomosis may reduce the incidence of delayed gastric emptying following pancreaticoduodenectomy, but does not shorten the length of hospital stay.

Mission (nearly) impossible: ERCP using an oblique cap with suction cannulation in a diffusely strictured duodenal stump after Billroth II with Braun enteroenterostomy.

Mission (nearly) impossible: ERCP using an oblique cap with suction cannulation in a diffusely strictured duodenal stump after Billroth II with Braun enteroenterostomy.

Addition of Braun Enteroenterostomy – Impact on early outcomes in Pancreaticoduodenectomy

Background: Morbidity following Pancreaticoduodenectomy still remains high.Few studies have shown decrease in morbidity with the addition of Braun enteroenterostomy (BE). Our aim was to determine any possible benefit with addition of BE to the standard reconstruction after pancreaticoduodenectomy Methods: All patients who underwent pancreaticoduodenectomy from Feb2011 to July2016 were included.They were randomized to undergo either Standard reconstruction (Group A)or with addition of Braun enteroenterostomy (Group B). Outcomes were compared between 2 groups and the results were analyzed. P value of <0.05 was considered significant Results: 104 patients were included.Group A included 56 patients who underwent standard reconstruction and Group B had 48 patients with addition of Braun enteroenterostomy. The demographic profile,tumor characteristics, and biochemical profile were similar in 2 groups. Mean operating time, Intraoperative blood loss and requirement for transfusion were similar.The incidence of pancreatic fistula (POPF) did not differ significantly in 2 groups (14/56,25% in group A vs. 8/48,16.6% in group B; p= 0.42). The Incidence of DGE was not statistically different in 2 groups (20/56,35.7% in group A vs. 12/48,25% in group B;p=0.77). Infection rates were similar in two groups. Mean hospital stay was similar in both groups (11.2 in group A vs. 10.7 days in group B; p=0.68) Conclusion: The outcomes of patients after pancreaticoduodenectomy were not altered by addition of Braun enteroenterostomy

Addition of Braun enteroenterostomy – Impact on early outcomes in pancreaticoduodenectomy

Addition of Braun enteroenterostomy – Impact on early outcomes in pancreaticoduodenectomy

Braun anastomosis lowers the incidence of delayed gastric emptying following pancreaticoduodenectomy: a meta-analysis

BackgroundDelayed gastric emptying (DGE) is one of the most frequent complications following pancreaticoduodenectomy. This meta-analysis aimed to evaluate the impact of Braun enteroenterostomy on DGE following pancreaticoduodenectomy.MethodsA systematic review of the literature was performed to identify relevant studies. Statistical analysis was carried out using Review Manager software 5.3.ResultsEleven studies involving 1672 patients (1005 in Braun group and 667 in non-Braun group) were included in the meta-analysis. Braun enteroenterostomy was associated with a statistically significant reduction in overall DGE (odds ratios [OR] 0.32, 95% confidence intervals [CI] 0.24 to 0.43; P <0.001), clinically significant DGE (OR 0.27, 95% CI 0.15 to 0.51; P <0.001), bile leak (OR 0.50, 95% CI 0.29 to 0.86; P = 0.01), and length of hospital stay (weighted mean difference -1.66, 95% CI -2.95 to 00.37; P = 0.01).ConclusionsBraun enteroenterostomy minimizes the rate and severity of DGE following pancreaticoduodenectomy.

Pancreatoduodenectomy: Brazilian practice patterns

Background: Pancreatoduodenectomy is a technically challenging surgical procedure with an incidence of postoperative complications ranging from 30% to 61%. The procedure requires a high level of experience, and to minimize surgery-related complications and mortality, a high-quality standard surgery is imperative. The aim of this study is to understand the Brazilian practice patterns for pancreatoduodenectomy. Methods: A questionnaire was designed to obtain an overview of the surgical practice in pancreatic cancer, specific training, and experience in pancreatoduodenectomy. The survey was sent to members who declared an interest in pancreatic surgery. Results: A total of 60 questionnaires were sent, and 52 have returned (86.7%). The Southeast had the most survey respondents, with 25 surgeons (48.0%). Only two surgeons (3.9%) performed more than 50% of their pancreatoduodenectomies by laparoscopy. A classic Whipple procedure was performed by 24 surgeons (46.2%) and a standard International Study Group on Pancreatic Surgery lymphadenectomy by 43 surgeons (82.7%). For reconstruction, pancreaticojejunostomy was performed by 49 surgeons (94.2%), single limb technique by 41(78.9%), duct-to-mucosa anastomosis by 38 (73.1%), internal trans-anastomotic stenting by 26 (50.0%), antecolic route of gastric reconstruction by 39 (75.0%), and Braun enteroenterostomy was performed by only six surgeons (11.5%). Prophylactic abdominal drainage was performed by all surgeons, and somatostatin analogues were utilized by six surgeons (11.5%). Early postoperative enteral nutrition was routine for 22 surgeons (42.3%), and 34 surgeons (65.4%) reported routine use of a nasogastric suction tube. Conclusion: Heterogeneity was observed in the pancreatoduodenectomy practice patterns of surgeons in Brazil, some of them in contrast with established evidence in the literature.

Addition of Mesh Reinforcement for Pancreatic Stump and Braun Enteroenterostomy after Pancreaticoduodenectomy: A Single Institution Experience

The morbidity rate after pancreaticoduodenectomy (PD) remains high and a modified digestive reconstruction may affect the postoperative complications. We investigated a new modification of PD by adding mesh reinforcement for the pancreatic stump and Braun enteroenterostomy with the aim of reducing postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE), respectively. From November 2010 to April 2015, 81 consecutive patients who underwent modified PD were retrospectively reviewed. The clinically relevant POPF and DGE rates were 4.9 and 6.1 per cent, respectively. The overall mortality rate was 2.4 per cent. The incidence of overall postoperative complications was 46.9 per cent, with 17.2 per cent considered as major complications (Clavien grades 3-5). The median postoperative length of hospital stay was 17 days (range 10-119 days). For patients who had major complications, median postoperative length of hospital stay increased significantly (22 vs 13 days, P = 0.001), as compared with those patients with no complications. The new modified digestive reconstruction after PD seems safe and reliable with low clinically relevant POPF and DGE rates. Further prospective controlled trials are essential to support these results.

Addition of Braun enteroenterostomy to standard reconstruction in pancreaticoduodenectomy: impact on early outcomes

Background: Morbidity following Pancreaticoduodenectomy still remains high. Few studies have shown decrease in morbidity with the addition of Braun Enteroenterostomy (BEE). Aim of the present study was to determine any possible benefit with addition of BE to the standard reconstruction after pancreaticoduodenectomy.Methods: In this prospective randomized controlled study, all patients who underwent Pancreaticoduodenectomy from June 2012 to July 2016 were included. They were randomized to undergo either standard reconstruction (Group A) or with addition of Braun Enteroenterostomy to standard reconstruction (Group B). Outcomes were compared between 2 groups and the results were analyzed. P value of &lt;0.05 was considered significant.Results: 104 patients were included in the study. Group A included 56 patients who underwent standard reconstruction and Group B had 48 patients who had addition of BEE to standard reconstruction. The demographic profile, tumour characteristics, and biochemical profile were similar in 2 groups. Mean operating time and Intra operative blood loss were similar. The incidence of pancreatic fistula (POPF) did not differ significantly in 2 groups (14/56, 25% in group A versus 8/48, 16.6% in group B; p = 0.42). The incidence of Delayed Gastric Emptying (DGE) was not statistically different in 2 groups (20/56, 35.7% in group A versus 12/48, 25% in group B; p=0.77). Infection rates were similar in two groups. Mean hospital stay was similar in both groups (11.2 days versus 10.7 days; p=0.68).Conclusions: The outcomes of patients after pancreaticoduodenectomy were not altered by addition of Braun Enteroenterostomy to standard reconstruction.

PANCREATODUODENECTOMY: BRAZILIAN PRACTICE PATTERNS.

ABSTRACT Background:Pancreatoduodenectomy is a technically challenging surgical procedure with an incidence of postoperative complications ranging from 30% to 61%. The procedure requires a high level of experience, and to minimize surgery-related complications and mortality, a high-quality standard surgery is imperative. Aim:To understand the Brazilian practice patterns for pancreatoduodenectomy. Method:A questionnaire was designed to obtain an overview of the surgical practice in pancreatic cancer, specific training, and experience in pancreatoduodenectomy. The survey was sent to members who declared an interest in pancreatic surgery. Results: A total of 60 questionnaires were sent, and 52 have returned (86.7%). The Southeast had the most survey respondents, with 25 surgeons (48.0%). Only two surgeons (3.9%) performed more than 50% of their pancreatoduodenectomies by laparoscopy. A classic Whipple procedure was performed by 24 surgeons (46.2%) and a standard International Study Group on Pancreatic Surgery lymphadenectomy by 43 surgeons (82.7%). For reconstruction, pancreaticojejunostomy was performed by 49 surgeons (94.2%), single limb technique by 41(78.9%), duct-to-mucosa anastomosis by 38 (73.1%), internal trans-anastomotic stenting by 26 (50.0%), antecolic route of gastric reconstruction by 39 (75.0%), and Braun enteroenterostomy was performed by only six surgeons (11.5%). Prophylactic abdominal drainage was performed by all surgeons, and somatostatin analogues were utilized by six surgeons (11.5%). Early postoperative enteral nutrition was routine for 22 surgeons (42.3%), and 34 surgeons (65.4%) reported routine use of a nasogastric suction tube. Conclusion: Heterogeneity was observed in the pancreatoduodenectomy practice patterns of surgeons in Brazil, some of them in contrast with established evidence in the literature.