The pylorus-preserving partial pancreatoduodenectomy according to Transverso-Longmire is one of the most complex and demanding operations for surgeons as well as for patients. Depending on the expertise of the center as well as the surgeon, the mortality rate increases from less than 5% in centers specializing in pancreatic surgery to more than 10%. Pancreatic fistulas represent a major risk factor for postoperative mortality. Depending on the severity of the clinically relevant pancreatic fistula, the mortality rate increases to 40%. Several reconstruction techniques have been developed to minimize the risk of postoperative complications. The most commonly used reconstruction technique is the Child reconstruction. Here, the pancreaticojejunostomy, the hepaticojejunostomy, and the duodenojejunostomy are attached to a single jejunal loop. In this randomized-controlled study, the benefit of an additional anastomosis between the afferent and efferent loop of the duodenojejunostomy - also called Braun's anastomosis - is to be explored. This is intended to facilitate the outflow of bile and pancreatic fluids from the afferent loop while reducing reflux from the efferent loop, thus relieving the pressure on the pancreaticojejunostomy. This should reduce not only the rate of pancreatic fistulae but also the rate of postoperative complications per se.
