Effect of length of Proximal Jejunal Resection on the Incidence of Delayed Gastric Emptying Following Pylorus Resecting Pancreaticoduodenectomy (PrPD), a Randomised Controlled Trial

Abstract

Aim: To determine the role of length of proximal jejunal resection in the occurrence of Delayed Gastric Emptying following Pylorus resecting Pancreaticoduodenectomy (PrPD). Methods: Of the 137 patients enrolled, 97 patients were randomised to long segment (30cm) (n=46) and short segment(15cm)(n=51) proximal jejunal resection. Delayed Gastric Emptying (DGE) was defined as per ISPGS guidelines. Operative time, removal of NG tube, resumption of oral feed, morbidity, mortality and overall hospital stay was compared. Results: Both the groups were comparable in terms of demographic and operative data. The overall incidence of delayed gastric emptying in this study was 58.8% with long segment 47.8% and short segment 68.6% (p=0.010).Incidence of Clinically relevant delayed gastric emptying was lesser in the long segment group (21.7% vs 54.9%, P=0.001). The incidence of Primary delayed gastric emptying was significantly lower in long segment group (26.1% vs. 31.3%, P=0.029) and there was a trend towards fewer incidence of secondary delayed gastric emptying (21.7% vs. 37.2%, P=0.096). Patients in the long segment group had early removal of NG tube (5.13±4.39 vs. 8.28±5.59 days, P=0.046) and early resumption of solid diet (7.6±4.51 vs. 10.4±5.61 days P=0.011). The post-operative hospital stay was comparable in both groups. Other post-operative complications were comparable in both the groups. Conclusion: Resection of 30 cm of proximal jejunum decreases the incidence of delayed gastric emptying both primary and secondary. This translates into early removal of NG tube, and early resumption of oral feed.