SYSTEMATIC REVIEWS AND META-ANALYSIS Mortality and postoperative complications after different types of surgical reconstruction following pancreaticoduodenectomy—a systematic review with meta-analysis Stephan Schorn 1 & Ihsan Ekin Demir 1 & Thomas Vogel 1 & Rebekka Schirren 1 & Daniel Reim 1 & Dirk Wilhelm 1 & Helmut Friess 1 & Güralp Onur Ceyhan 1 Received: 28 March 2018 /Accepted: 6 February 2019 /Published online: 28 February 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Background Pancreaticoduodenectomy/PD is a technically demanding pancreatic resection. Options of surgical reconstruction include (1) the child reconstruction defined as pancreatojejunostomy/PJ followed by hepaticojejunostomy/HJ and the gastrojejunostomy/GJ Bthe standard/s-Child,^ (2) the s-child reconstruction with an additional Braun enteroenterostomy BBE- Child,^ or (3) Isolated-Roux-En-Y-pancreaticojejunostomy BIso-Roux-En-Y,^ in which the pancreas anastomosis is reconstruct- ed in a separate loop after the GJ. Yet, the impact of these reconstruction methods on patients’ outcome has not been sufficiently compared in a systematic manner. Methods A systematic review and meta-analysis were conducted according to the Preferred-Reporting-Items-for-Systematic- review-and-Meta-Analysis/PRISMA-guidelines by screening Pubmed/Medline, Scopus, Cochrane Library and Web-of-Science. Articles meeting predefined criteria were extracted and meta-analysis was performed. Results Nineteen studies were identified comparing BE-Child or Isolated-Roux-En-Y vs. s-Child. Compared to s-Child neither BE-Child (p = 0.43) nor Iso-Roux-En-Y (p = 0.94) displayed an impact on postoperative mortality, whereas BE-Child showed less postoperative complications (p = 0.02). BE-Child (p = 0.15) and Iso-Roux-En-Y (p = 0.61) did not affect postoperative pancreatic fistula/POPF in general, but BE-Child was associated with a decrease of clinically relevant POPF (p = 0.005), clinically relevant delayed gastric emptying/DGE B/C (p = 0.004), bile leaks (p = 0.01), and hospital stay (p = 0.06). BE-Child entailed also an increased operation time (p = 0.0002) with no impact on DGE A/B/C, hemorrhage, surgical site infections and pulmonary complications. Conclusion BE-Child is associated with a decreased risk for postoperative complications, particularly a decreased risk for clinically relevant DGE, POPF, and bile leaks, whereas Iso-Roux-En-Y does not seem to affect the clinical course after PD. Therefore, BE seems to be a valuable surgical method to improve patients’ outcome after PD. Keywords Braun enteroenterostomy . Braun anastomosis . Child reconstruction . Iso-Roux-En-Y-reconstruction . Pancreas surgery . Pancreaticoduodenectomy Introduction Incidence of postoperative complications after partial pancreaticoduodenectomy/PD did not alter within the last de- cades with morbidity rates reaching up to 60%, whereas mor- tality rates could be successfully dropped down to 3–5% in specialized high volume centers [1–4]. In this context, delayed gastric emptying/DGE and postoperative pancreatic fistula/ POPF belong to the most feared complications after PD. Although DGE also occurs in other upper GI operations such as partial gastrectomy or esophagectomy with vagotomy [5–10], it is especially common after PD with an incidence Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-019-01762-5) contains supplementary material, which is available to authorized users. * Helmut Friess helmut.friess@tum.de 1 School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany Langenbeck's Archives of Surgery (2019) 404:141–157 https://doi.org/10.1007/s00423-019-01762-5