Abstract
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China Background: Delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD) or pylorus-preserving PD (PPPD) remains a debatable problem. The superiority of either procedure in terms of DGE incidence was still unclear. Aim: To compare the incidence of DGE and other perioperative outcomes after PPPD or PD by one surgeon in a certain period. Methods: From January 2009 to December 2010, we started to substitute PPPD for PD in surgical treatment for periampullary lesions. During these two years, 37 cases of PPPD and 59 PD were performed by one surgeon (Y. Miao) in the setting of a tertiary hospital in southern China. Definition and grading of DGE were according to ISGPS recommendation. Data were reviewed and analyzed in retrospective way. Results: Two groups were comparable in terms of age and male/female ratio (59.0 12.2 for PD vs. 58.4 12.0 for PPPD, p1⁄40.834; 24/13 vs. 38/21, p1⁄40.964; respectively). Due to a different clinical pathway in our country, our practice tends to keep nasogastric tube for a longer time. This lead to high incidence rates of DGE in our patients, 78.4% in PD group, and slightly higher in PPPD group (79.9%), but not reaching statistical difference (p1⁄40.880). However, severe DGE (grade B+C) happenedmore in PPPD group compared with PD group (21/59 vs. 3/37, p1⁄40.002). Other complications, including pancreatic fistula, hemorrhage, chyle fistula and intraabdominal infectionswere distributed equally in these two groups. Both groups had no mortality. Patients had a longer length of hospital stay after PPPD compared with those after PD (19.3 11.3 days vs. 17.4 7.5 days, p1⁄40.363). Conclusion: Pylorus-preserving in PD will lead to more severe DGE in southern Chinese population. To our knowledge, this is the first related report on DGE after PPPD in this large population.
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