Double loop reconstruction with isolated gastric limb after pancreaticoduodenectomy

Abstract

Background: Delayed gastric emptying (DGE) and postoperative pancreatic fistula (POPF) remain the most frequent causes of morbidity after pancreaticoduodenectomy. Roux-en-Y double-loop reconstruction with an isolated gastric limb (RIGL) has been proposed to reduce these complications, but clinical evidence remains limited. The aim is to assess the effect of RIGL on the incidence of DGE and POPF following pancreaticoduodenectomy compared with conventional single-loop reconstruction (SLR). Methods: This intervention study was conducted in the Department of Hepatobiliary, Pancreatic and Liver Transplant Surgery, Bangladesh Medical University, from December 2024 to November 2025. Adult patients undergoing elective pancreaticoduodenectomy were allocated to either conventional SLR or Roux-en-Y double-loop reconstruction with an isolated gastric limb (DLR) using a predefined alternating sequence. Thirty patients were included (SLR, 15; DLR, 15). Postoperative outcomes were compared between groups. Results: Baseline demographic and clinical characteristics were comparable between groups. DGE occurred less frequently in the DLR group than in the SLR group (13.3% vs. 53.3%, P=0.02). Although POPF was less common following DLR (46.7% vs. 66.7%), the difference was not statistically significant (P=0.27). Rates of bile leakage, wound infection, pneumonia, and other postoperative complications were similar between groups. Mean hospital stay was shorter in the DLR group (16.2 vs. 19.5 days), but the difference was not statistically significant (P=0.19). No perioperative mortality or Grade C DGE/POPF was observed. Conclusion: RIGL significantly reduced DGE after pancreaticoduodenectomy without increasing other postoperative complications. Larger prospective studies are warranted to confirm these findings and further evaluate its impact on POPF-related outcomes.