Abstract
BackgroundDelayed gastric emptying (DGE) is a common complication of pancreaticoduodenectomy. We determined the efficiency of a new reconstruction technique, designed to preserve motilin-secreting cells and maximize the utility of their receptors, in reducing the incidence of DGE after pancreaticoduodenectomy. MethodsFrom April 2005 to September 2014, 217 consecutive patients underwent pancreaticoduodenectomy at our institution. Nine patients who underwent total pancreatectomy were excluded. We compared outcomes between patients who underwent pancreaticoduodenectomy with resection of the pyloric ring followed by proximal Roux-en-y gastrojejunal anastomosis (group I, n = 90) and patients who underwent standard pancreaticoduodenectomy with the orthotopic reconstruction technique (group II, n = 118). ResultsOverall and clinically relevant rates of DGE were significantly lower in group I than in group II (10 and 2.2 % vs. 57 and 24 %, respectively; p < 0.05). Length of hospital stay as a result of DGE was shorter in group I than in group II. In univariate analysis, older age, comorbidities, ASA grade 4, operative time, preoperative diabetes, standard reconstruction technique, and postoperative complications were significant risk factors for DGE. In multivariate analysis, older age, standard technique, and postoperative complications were independent risk factors for DGE. ConclusionOur new reconstruction technique reduces the occurrence of DGE after pancreaticoduodenectomy.
Highlights
Perioperative risk factors and postoperative intra-abdominal complications contribute to the overall incidence of Delayed gastric emptying (DGE), the disruption of neuro-humoral pathways remains the common denominator in all patients after PD that contributes to the occurrence of primary DGE
Because the concentration of motilin receptors and the velocity of propagation of migrating motor complex (MMC) activity decline from the proximal to the distal small intestine, we hypothesized that the effective stimulation of gastric emptying after PD may be achieved by preserving the gastric antrum and utilizing the proximal end of the first jejunal loop for reconstruction with the gastric antrum, followed by distal Roux-eny PJ and HJ anastomosis. In this prospective cohort pilot study, we examined whether the preservation of the gastric antrum with proximal Roux-eny gastrojejunal anastomosis (GJA) reduces the incidence of DGE when compared to standard PD using the orthotopic reconstruction technique
In a group of 202 patients who underwent elective PD, we found that the rate of DGE and the length of hospital stay related to DGE were significantly lower in group I patients who underwent PD with the new technique than in group II patients who underwent PD with the standard orthotopic technique
Summary
Delayed gastric emptying (DGE), a common complication of pancreaticoduodenectomy (PD), has an incidence ranging from 3 to 61 %, depending on the reconstruction technique and definition used.[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19] DGE is non-fatal and self-limiting, it contributes significantly to increased patient discomfort, hospital length of stay, and medical costs. Older age, comorbidities, ASA grade 4, operative time, preoperative diabetes, standard reconstruction technique, and postoperative complications were significant risk factors for DGE. Older age, standard technique, and postoperative complications were independent risk factors for DGE
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