Abstract
BackgroundPancreaticoduodenectomy is the procedure of choice for tumors of the head of the pancreas and periampulla. Despite advances in surgical technique and postoperative care, the procedure continues to carry a high morbidity rate. One of the most common morbidities is delayed gastric emptying with rates of 15%–40%. Following two prolonged cases of delayed gastric emptying, we altered our reconstruction to avoid this complication altogether. Subsequently, our patients underwent a classic pancreaticoduodenectomy with an undivided Roux-en-Y technique for reconstruction.MethodsWe reviewed the charts of our last 13 Whipple procedures evaluating them for complications, specifically delayed gastric emptying. We compared the outcomes of those patients to a control group of 15 patients who underwent the Whipple procedure with standard reconstruction.ResultsNo instances of delayed gastric emptying occurred in patients who underwent an undivided Roux-en-Y technique for reconstruction. There was 1 wound infection (8%), 1 instance of pneumonia (8%), and 1 instance of bleeding from the gastrojejunal staple line (8%). There was no operative mortality.ConclusionUse of the undivided Roux-en-Y technique for reconstruction following the Whipple procedure may decrease the incidence of delayed gastric emptying. In addition, it has the added benefit of eliminating bile reflux gastritis. Future randomized control trials are recommended to further evaluate the efficacy of the procedure.
Highlights
Pancreaticoduodenectomy is the procedure of choice for tumors of the head of the pancreas and periampulla
The operation classically involves removal of the pylorus and antrum; recently, surgeons have used a pyloruspreserving Whipple procedure to lower the incidence of postgastrectomy symptoms, such as delayed gastric emptying (DGE)
Delayed gastric emptying is defined as the need for a nasogastric tube for 10 or more days or reinsertion of the tube owing to vomiting [3], and it is one the most common problems encountered postoperatively
Summary
Pancreaticoduodenectomy is the procedure of choice for tumors of the head of the pancreas and periampulla. Despite advances in surgical technique and postoperative care, the procedure continues to carry a high morbidity rate. Pancreaticoduodenectomy (Whipple procedure) is the standard treatment for operable adenocarcinomas of the head of the pancreas, as well as for other periampullary tumors and in some cases of chronic pancreatitis. The operation classically involves removal of the pylorus and antrum; recently, surgeons have used a pyloruspreserving Whipple procedure to lower the incidence of postgastrectomy symptoms, such as delayed gastric emptying (DGE). Both methods – the standard and the pylorus-preserving Whipple – have their advocates, but each method continues to have gastroparesis as a postoperative problem
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