Objective:

To assess whether adjunctive Braun enteroenterostomy (BEE) decreases the incidence and severity of delayed gastric emptying (DGE) and postoperative morbidity following pancreatoduodenectomy (PD).

Approach:

• Data resources and search strategy: Comprehensive search of electronic databases from inception through November 4, 2025, following PRISMA guidelines.
• Eligibility criteria: Inclusion of RCTs or cohort studies comparing PD with and without BEE, reporting on primary outcomes like DGE incidence or postoperative morbidity.
• Screening and risk of bias assessment: Assessment of certainty for DGE and morbidity analyses using GRADE approach and risk of bias tools.
• Extracted outcomes: Assessment of baseline clinical variables, intraoperative variables, and postoperative endpoints including DGE and overall morbidity.
• Statistical analysis: Pooled means and proportions analyzed with random-effects method; continuous outcomes evaluated with generic inverse variance method.

Key Findings:

• DGE occurs in approximately 30-60% of PD cases, with reported frequencies reaching 62%.
• Studies show inconsistent findings regarding the effectiveness of BEE in mitigating DGE.
• The need for an updated systematic review and meta-analysis was prompted by recent RCTs and observational studies.

Interpretation:

Conflicting evidence from various studies leaves the role of BEE in reducing DGE and postoperative morbidity after PD unclear.

Limitations:

• Inclusion limited to studies published in English.
• Exclusion of case reports, case series, and studies with invasive procedures beyond PD.

Conclusion:

The systematic review and meta-analysis aims to clarify the effectiveness of BEE in patients undergoing PD.