What is enteroenterostomy?
Braun enterostomy is a type of anastomosis done following a major surgery like pancreaticoduodenectomy (removal of pancreas and a part of the intestine).
Enteroenterostomy is an anastomosis (connection) between one part of the small bowel to another (jejunum or ileum).
The entire small intestine is around 20 feet long and is divided into three parts.
- The first part is called the duodenum (the stomach opens into the duodenum).
- The middle part is called the jejunum.
- The third and final part is called the ileum. The ileum opens into the large intestine.
When a part of the small or large intestine is resected (removed) because of intestinal pathology, the two sections of the remaining part of the intestine are joined together (anastomosis) to re-establish communication and continuity of the intestine. This surgical procedure is called intestinal anastomosis.
Why is enteroenterostomy done?
Enteroenterostomy is performed following the removal of part of the small intestine due to intestinal pathology. Intestinal resection and anastomosis are performed during the same procedure. The procedure may be done in adults and children.
Intestinal resection may be indicated in the following conditions:
- Intestinal gangrene (tissue death due to loss of blood supply)
- Malignancy (cancer)
- Benign tumors (e.g., intestinal polyps)
- Intussusception (when a part of the intestine gets stuck in its preceding part)
- Worm infestations with intestinal obstruction
- Infections like tuberculosis complicated with stricture or perforation
- Perforations due to infection, ulcers, or trauma
- Damage to the intestine due to radiation therapy, especially when complicated with bleeding, stricture, or perforation
- Inflammatory bowel disease, ulcerative colitis, or Crohn’s disease
- Scarring and adhesions causing the intestinal block
- Chronic constipation
- Birth defects of the intestine (e.g., Meckel’s diverticulum, cysts, Hirschsprung disease)
- For intestinal bypass (short circuit) to relieve an obstruction or after the closure of intestinal perforation.
- As a part of the Braun loop of jejunum, also called Braun enteroenterostomy, which is performed as a part of other surgeries like bariatric surgery
What is Braun enteroenterostomy?
Braun enterostomy is a type of anastomosis done following a major surgery like pancreaticoduodenectomy (removal of pancreas and a part of the intestine). It may also be done following other major gastric procedures.
Braun enteroesterostomy is a side-to-side anastomosis between two segments of the jejunum (small intestine) away from the primary site of surgery.
It may decrease the postoperative morbidity, but the results have not been consistent.
When can enteroenterostomy not be done?
The surgery may not be able to be performed when there is a high risk of anastomotic leakage. In such cases, the surgeon may advise alternative techniques. Some conditions in which enteroenterostomy may be contraindicated are:
- Severe sepsis (widespread infection in the body)
- Poor nutritional status
- Cancer metastasis (widespread of cancer cells in the body)
- Questionable viability of the intestine (a large amount of tissue in the intestine is dead because the blood supply has been cut off)
- Fecal contamination or infection in the abdomen
- Unhealthy and diseased intestine
What are the types of enteroenterostomy?
The three main types based on the surgical technique. The surgeon decides on which technique would be ideal based on the condition. The three techniques are:
- Side-to-side
- End-to-end
- End-to-side
Side-to-side anastomosis
In this technique, the sides of each part of the intestine are connected either with sutures or surgical staples rather than the two ends.
End-to-end anastomosis
In this technique, the two open ends of the intestines are connected together.
End-to-side anastomosis
In this technique, the end of the intestine that is smaller is connected to the side of the larger section.
What are the complications of enteroenterostomy?
Like any major surgery, there is a risk for complications. Some may be on the table or in the post-operative period. Some common complications are:
- Localized blood clot and smaller blood clots that enter the blood vessels, causing heart and lung complications
- Bleeding
- Reaction to anesthesia
- Scarring and adhesions, causing intestinal narrowing and/or blockage
- Damage to surrounding structures
- Infection
- Wound dehiscence (a condition in which the cut made during a surgical procedure separates or ruptures after being stitched together)
- Anastomotic leak (intestinal contents may leak through the site of anastomosis), which may lead to systemic infection
- Altered bowel movements
How long does it take for anastomosis to heal?
After surgery, the patient may have to stay in the hospital for up to seven days. Patients can mobilize 48 to 72 hours after surgery.
The small intestine heals very quickly. It usually takes two to three weeks for the anastomosis to heal and for the patients to recover. The large intestine anastomosis may take longer to heal.
Patients may experience fatigue and discomfort for six to eight weeks, making certain activities difficult like vigorous exercise, sports, or lifting heavy objects. Most patients are able to return to their pre-operative activities in six to eight weeks.
