Does Pyloric-ring Resection in Pancreaticoduodenectomy Prevent Delayed Gastric Emptying?

Abstract

Objective: Delayed gastric emptying (DGE) is a common, post pancreaticoduodenectomy (PD) complication, which prolongs hospital stay, increases the cost of treatment and delays adjuvant therapy. Although, pylorospasm is one of the proposed mechanisms, the results of pyloric ring resection PD remain controversial. Hence, this study investigated whether pyloric ring resection PD decreased the incidence of DGE.Material and Methods: Between June, 2015 and July, 2018; 74 patients underwent a PD for periampullary lesions, of whom 25 patients received pylorus-preserving PD (PPPD) and 49 patients received pyloric-ring resection PD (PRPD). DGE was classified according to the International Study Group of Pancreatic Surgery.Results: The incidence of DGE in the PPPD group and PRPD group were 48.0% (12 of 25 patients) and 20.4% (10 of 49 patients), respectively (p-value=0.029). Factors associated with DGE were pyloric preserving [adjusted Odds ratio (OR)=8.26, 95% confidence interval (CI): 1.96-34.82, p-value=0.002], preoperative biliary drainage (adjusted OR=0.19, 95% Cl: 0.05-0.78, p-value=0.013) and postoperative intraabdominal collection (adjusted OR=37, 95% Cl: 5.68-241.24, p-value<0.001).Conclusion: PRPD demonstrated a significant decrease of DGE, and should be one of the standard surgical treatments for periampullary carcinoma.