Simple Loop versus Roux-En-Y Reconstruction after Pancreaticoduodenectomy: Randomized Controlled Study

Background: Pancreaticoduodenectomy (PD) is a complex procedure often performed to treat tumors in the pancreas and periampullary region. Postoperative complications, particularly those related to reconstruction, can significantly affect recovery and patient outcomes.Aim: This Randomized Controlled Clinical Trial aims to evaluate our institution's experience with patients diagnosed with periampullary and pancreatic head tumors who underwent PD. The study compares the effectiveness of two reconstruction techniques—Simple Loop and Roux-en-Y—in improving postoperative outcomes, with the goal of identifying the optimal approach for enhanced clinical results.Patients and Methods: The study involved 20 patients diagnosed with pancreatic head and periampullary tumors, all of whom underwent PD. Patients were randomly assigned to two groups: Group 1 (n=10) received the simple loop reconstruction, while Group 2 (n=10) received the Roux-en-Y reconstruction. Preoperative, intraoperative, and postoperative data were collected and compared across both groups.Results: The surgery duration was significantly longer in the Roux-en-Y group (p<0.001). No significant differences were found in the type of PD (pylorus-preserving or not), blood loss, blood transfusions, pancreatic duct diameter (≤3 mm or >3 mm), pancreatic consistency (soft or hard), type of anastomosis, or the use of stents. There were no cases of hospital mortality. The morbidity rate was 60% in the Roux-en-Y group and 70% in the simple loop group.Conclusion: The Roux-en-Y reconstruction, which optimally utilizes the proximal jejunum abundant in motilin receptors, seems to diminish the occurrence and severity of delayed gastric emptying following PD.