Impact of the gastrojejunal anatomical position as the mechanism of delayed gastric emptying following pancreatoduodenectomy

Abstract

Objective: This study investigated the impact of gastrojejunal anatomical position on the incidence of delayed gastric emptying (DGE) following pancreatoduodenectomy. Methods: A total of 160 patients were included in the retrospective analysis. The relative anatomical position of the gastrojejunostomy was evaluated using the coronal and sagittal plane images of computed tomography on postoperative day 7; the coronal cardia anastomotic angle (CCAA) and the sagittal fundus anastomotic angle (SFAA) were measured. In the validation study, 64 consecutive patients were enrolled, and gastric emptying was evaluated using water-soluble contrast medium. The extent of gastric emptying was graded as grade I (no gastric dilatation and no stasis), grade II (gastric dilatation but no stasis), and grade III (gastric dilatation and stasis). Results: Patients with grades B (n=8) and C (n=22) DGE were included in the “DGE group” (n=30), and the others were included in the “non-DGE group” (n=130). The CCAA was not significantly different between the two groups, whereas the SFAA was significantly greater in the DGE group compared to the non-DGE group (median 50.3 vs. 64.5 degree, p<0.001). Multivariate analysis, including various risk factors of DGE, indicated that an SFAA >60 degrees was the only independent risk factor of DGE (odds ratio, 16.59). In the validation study, the median degree of SFAA increased as the gastric emptying grade increased (grade I, 44.3 degrees; grade II, 55.3 degrees; grade III, 60.7 degrees; p=0.014 by ANOVA). Conclusions: The gastrojejunal anatomical position following pancreatoduodenectomy has a significant impact on the incidence of DGE.