Delayed Gastric Emptying Grade Research Articles

Impact of marmara-yegen cuttıng gastrojejunostomy on delayed gastrıc emptyıng after pancreatoduodenectomy: ınıtıal results.

Delayed gastric emptying (DGE) is one of the most common reasons for morbidity after pancreatoduodenectomy. The technical characteristics of anastomosis that could be affected by surgeon may offer a relevant chance to improve postoperative DGE rates. We investigated the effect of a technical modification of gastrojejunostomy after the classical pancreaticoduodenectomy on DGE. A total of 161 patients underwent classical pancreaticoduodenectomy (with 20-40 percent antrectomy) due to pancreatic adenocarcinoma at the Department of General Surgery, Marmara University, School of Medicine Hospital, from February 2019 to May 2023, and those who met the inclusion criteria were enrolled. One hundred twenty patients had undergone classical end-to-side gastrojejunostomy (Classical GJ group), and 41 had undergone Marmara-Yegen cutting side-to-side gastrojejunostomy (M-Yc group). DGE was defined according to the International Working Group on Pancreatic Surgery, and postoperative DGE rates of both groups were compared. In addition, multivariate analysis was performed to identify possible independent predictive factors for DGE. The total incidence of DGE was 31% in the Classical GJ group and 17% in the (M-Yc group). Although there was no significant difference between the groups regarding DGE and DGE grades (p = 0.1), DGE was distinctly lower in the M-Yc GJ group. In multi-variant analysis, Clavien-Dindo grade 3a and above postoperative complication was determined as independent predictors for DGE. We tried to explain the mechanism of DGE in terms of anatomical configuration. The incidence and severity of DGE decreased in patients who underwent M-Yc GJ.

Duodenopancreatectomía cefálica tipo Whipple versus duodenopancreatectomía con preservación pilórica. Estudio retrospectivo

IntroductionControversy exists in the literature as to the best technique for pancreaticoduodenectomy (PD), whether pyloric-preserving (PD-PP) or Whipple's technique (with antrectomy [PD-W]), the former being associated with a higher frequency of delayed gastric emptying (DGE). MethodsRetrospective and comparative study between PD-PP technique (n=124 patients) and PD-W technique (n=126 patients), in patients who were operated for tumors of the pancreatic head and periampullary region between the period 2012 and 2023. ResultsSurgical time was longer, although not significant, with the PD-W technique. Pancreatic and peripancreatic tumor invasion (p=0.031) and number of lymph nodes resected (p<0.0001) reached statistical significance in PD-W, although there was no significant difference between the groups in terms of lymph node tumor invasion.Regarding postoperative morbimortality (medical complications, postoperative pancreatic fistula [POPF], hemorrhage, RVG, re-interventions, in-hospital mortality, Clavien-Dindo complications), ICU and hospital stay, no statistically significant differences were observed between the groups. During follow-up, no significant differences were observed between the groups for morbidity and mortality at 90 days and survival at 1, 3 and 5 years. Binary logistic regression analysis for DGE showed that binary relevant POPF grade B/C was a significant risk factor for DGE. ConclusionsPostoperative morbidity and mortality and long-term survival were not significantly different with PD-PP and PD-W, but POPF grade B/C was a risk factor for DGE grade C.

Whipple’s cephalic pancreaticoduodenectomy versus pyloric-preserving pancreaticoduodenectomy. Retrospective study

IntroductionControversy exists in the literature as to the best technique for pancreaticoduodenectomy (PD), whether pyloric preservation (PP-CPD) or Whipple's technique (with antrectomy [W-CPD]), the former being associated with a higher frequency of delayed gastric emptying (DGE). MethodsRetrospective and comparative study between PP-CPD technique (n = 124 patients) and W-CPD technique (n = 126 patients), in patients who were operated for tumors of the pancreatic head and periampullary region between the period 2012 and 2023. ResultsSurgical time was longer, although not significant, with the W-CPD technique. Pancreatic and peripancreatic tumor invasion (p = 0.031) and number of lymph nodes resected (p < 0.0001) reached statistical significance in W-CPD, although there was no significant difference between the groups in terms of lymph node tumor invasion.Regarding postoperative morbimortality (medical complications, postoperative pancreatic fistula [POPF], hemorrhage, RVG, re-interventions, in-hospital mortality, Clavien–Dindo complications), ICU and hospital stay, no statistically significant differences were observed between the groups. During follow-up, no significant differences were observed between the groups for morbidity and mortality at 90 days and survival at 1, 3 and 5 years. Binary logistic regression analysis for DGE showed that binary relevant POPF grade B/C was a significant risk factor for DGE. ConclusionsPostoperative morbidity and mortality and long-term survival were not significantly different with PP-CPD and W-CPD, but POPF grade B/C was a risk factor for DGE grade C.

Impact of posterior wall gastrojejunostomy versus anterior wall gastrojejunostomy in pancreaticoduodenectomy on delayed gastric emptying and enhanced recovery: a prospective study

Background Pancreaticoduodenectomy (Whipple operation) is considered the main surgical management for duodenal, pancreatic head, and lower end common bile duct neoplasm. Gastrojejunostomy orientation has a direct impact on enteral feeding and delayed gastric emptying (DGE). Aim The primary outcomes were reviewing the effect of changing the orientation of gastrojejunostomy either anterior wall vertical gastrojejunostomy versus posterior wall vertical gastrojejunostomy on DGE, early enteral feeding, leakage, and overall enhanced recovery with early start of chemotherapy. Patients and methods A prospective randomized trial 55 patients total number of patients after substraction of lost follow up was 50 patients and were divided into two group; group A: 27 patients underwent posterior wall gastrojejunostomy and group B: 23 patients underwent anterior wall gastrojejunostomy both techniques done in antecolic vertical manner. Results Operative time, postoperative bleeding, and leakage was not significantly different between the two groups. The total incidence of DGE was significantly lower in group A (posterior wall vertical) than group B (anterior wall vertical), regarding grades of DGE grade a was significantly lower in group A while the incidence in grades B and C was not significantly different regarding the number of patients. Ryle removal and starting oral intake was earlier and statistically significant in posterior wall vertical gastrojejunostomy when compared to anterior wall vertical gastrojejunostomy. Readmission, the actual use of prokinetics and need for nutritional support was higher in group B (anterior wall vertical gastrojejunostomy) than group A (posterior wall vertical gastrojejunostomy) but was not statistically significant. Conclusions Posterior wall vertical gastrojejunostomy has a better overall significant better outcome regarding early enteral feeding and DGE over anterior wall vertical gastrojejunostomy group also has better enhanced recovery and earlier time of starting chemotherapy. This topic should be evaluated in depth in a large-volume studies.

Early oral feeding versus nasojejunal early enteral nutrition in patients following pancreaticoduodenectomy: a propensity score-weighted analysis of 428 consecutive patients.

Notwithstanding that significant medical progress has been achieved in recent years, the optimal nutritional support method following pancreaticoduodenectomy (PD) remains uncertain. This study compared the safety and feasibility of early oral feeding (EOF) with nasojejunal early enteral nutrition (NJEEN) after PD. A retrospective cohort study was conducted on 428 consecutive patients who underwent PD between August 2018 and December 2020. During the first study phase, the routine postoperative feeding strategy was NJEEN, later replaced by EOF during the second study phase. The primary outcome was the incidence of delayed gastric emptying (DGE) following PD. Propensity score weighting (PSW) was used to control for confounding factors. 440 patients underwent PD during the overall study period, with 438 patients aged 18 years and older. Ten patients experienced accidental tube dislodgement or migration and were excluded from the study based on the exclusion criteria. Finally, 211 patients and 217 patients underwent EOF and NJEEN, respectively. After PSW, it was observed that patients who underwent postoperative EOF experienced a significantly lower DGE (B/C) rate compared to those who underwent postoperative NJEEN (7.38% (31/424) vs. 14.97% (62/413), P=0.0005). Subgroup analyses according to the presence of soft pancreatic texture yielded consistent results. The EOF group exhibited lower DGE grade, DGE (B/C) rate (5.90% (11/194) vs. 22.07% (43/193), P<0.0001), postoperative gastrointestinal endoscopic intervention rate, and Clavien-Dindo Grade III or higher rate. EOF is superior to NJEEN in reducing the incidence of grade B/C DGE after PD. The EOF procedure is safe and feasible and should be recommended as the optimal postoperative feeding method following PD.

Obesity Does Not Influence Delayed Gastric Emptying Following Pancreatoduodenectomy.

Simple SummaryOver the last decades the number of obese patients has been increasing. Not only is obesity associated with other diseases such as cardiovascular diseases, diabetes and asthma but obese patients are also at a higher risk for developing different types of cancers, for instance pancreatic cancer with a consecutive increased need for pancreatic surgery. Even though it is not life threatening, impaired gastric motility, also known as delayed gastric emptying, has still remained the most common complication after pancreatic surgery. However, the data about obesity on postoperative outcome after pancreatic surgery are inconsistent, specifically in relation to delayed gastric emptying. The goal of this study was to investigate the impact of obesity on postoperative outcome, specifically on delayed gastric emptying, after pancreatic surgery. Our data show no difference in the occurrence and severity of delayed gastric emptying in patients with obesity compared to non-obese patients. Moreover, the overall mortality rate did not differ between the two groups. In summary, our data show that obese patients are not put at a higher risk in regard to postoperative outcome, which makes pancreatic surgery a feasible procedure in the obese patient, specifically in relation to delayed gastric emptying.Background: The data about obesity on postoperative outcome after pancreatoduodenectomy (PD) are inconsistent, specifically in relation to gastric motility and delayed gastric emptying (DGE). Methods: Two hundred and eleven patients were included in the study and patients were retrospectively analyzed in respect to pre-existing obesity (obese patients having a body mass index (BMI) ≥ 30 kg/m2 vs. non-obese patients having a BMI < 30 kg/m2, n = 34, 16% vs. n = 177, 84%) in relation to demographic factors, comorbidities, intraoperative characteristics, mortality and postoperative complications with special emphasis on DGE. Results: Obese patients were more likely to develop clinically relevant pancreatic fistula grade B/C (p = 0.008) and intraabdominal abscess formations (p = 0.017). However, clinically relevant DGE grade B/C did not differ (p = 0.231) and, specifically, first day of solid food intake (p = 0.195), duration of intraoperative administered nasogastric tube (NGT) (p = 0.708), rate of re-insertion of NGT (0.123), total length of NGT (p = 0.471) or the need for parenteral nutrition (p = 0.815) were equally distributed. Moreover, mortality (p = 1.000) did not differ between the two groups. Conclusions: Obese patients do not show a higher mortality rate and are not at higher risk to develop DGE. We thus show that in our study, PD is feasible in the obese patient in regard to postoperative outcome with special emphasis on DGE.

Chronic Liver Disease Increases Mortality Following Pancreatoduodenectomy.

According to the International Study Group of Pancreatic Surgery (ISGPS), data about the impact of pre-existing liver pathologies on delayed gastric emptying (DGE) after pancreatoduodenectomy (PD) according to the definitions of the International Study Group of Pancreatic Surgery (ISGPS) are lacking. We therefore investigated the impact of DGE after PD according to ISGPS in patients with liver cirrhosis (LC) and advanced liver fibrosis (LF). Patients were analyzed with respect to pre-existing liver pathologies (LC and advanced LF, n = 15, 6% vs. no liver pathologies, n = 240, 94%) in relation to demographic factors, comorbidities, intraoperative characteristics, mortality and postoperative complications, with special emphasis on DGE. DGE was equally distributed (DGE grade A, p = 1.000; B, p = 0.396; C, p = 0.607). Particularly, the first day of solid food intake (p = 0.901), the duration of intraoperative administered nasogastric tube (NGT) (p = 0.812), the rate of re-insertion of NGT (p = 0.072), and the need for parenteral nutrition (p = 0.643) did not differ. However, patients with LC and advanced LF showed a higher ASA (American Society of Anesthesiologists) score (p = 0.016), intraoperatively received more erythrocyte transfusions (p = 0.029), stayed longer in the intensive care unit (p = 0.010) and showed more intraabdominal abscess formation (p = 0.006). Moreover, we did observe a higher mortality rate amongst patients with pre-existing liver diseases (p = 0.021), and reoperation was a risk factor for higher mortality (p ≤ 0.001) in the multivariate analysis. In our study, we could not detect a difference with respect to DGE classified by ISGPS; however, we did observe a higher mortality rate amongst these patients and thus, they should be critically evaluated for PD.

Individual patient data meta-analysis of delayed gastric emptying after pylorus-preserving versus pylorus-resecting pancreatoduodenectomy

Abstract Objective Some studies have indicated that resecting the pylorus during partial pancreatoduodenectomy (PD) may lead to reduced delayed gastric emptying (DGE). Randomized controlled trials (RCTs) showed conflicting results regarding superiority of pylorus-resecting PD (prPD) compared to the pylorus-preserving procedure (ppPD). The aim of this individual patient data meta-analysis was to investigate risk factors on an individual patient level which may explain the observed differences between the existing RCTs. Methods RCTs comparing ppPD and prPD were searched systematically in MEDLINE, Web of Science and CENTRAL. Individual patient data (IPD) from existing RCTs were included. The primary endpoint was DGE according to the International Study Group of Pancreatic Surgery (ISGPS) adjusted for age, sex and body-mass-index (BMI). The meta-regression model was applied to the IPD of the RCTs. Mixed effects models were applied to perform meta-analyses. Results IPD from 418 patients (three RCTs) were used for quantitative synthesis. There was no significant statistical difference between ppPD and prPD regarding DGE adjusted for age, sex and BMI (OR 0.72; 95%-CI: 0.41 to 1.22) and DGE grade (RR 1.01; 95%-CI: 0.64 to 1.57). Regarding other relevant perioperative and postoperative outcome parameters, there were also no significant differences among the two techniques. Conclusion This IPD meta-analysis comparing preservation and resection of the pylorus during PD confirmed that the resection of the pylorus is not superior to the pylorus-preserving procedure regarding DGE. The pylorus should therefore be preserved whenever possible. Further RCT are futile, because their results are unlikely to change the pooled estimate for DGE.

Combined Antrectomy Reduces the Incidence of Delayed Gastric Emptying after Pancreatoduodenectomy

Background: There are a few reports that compare the rate of postoperative complications between subtotal stomach-preserving pancreatoduodenectomy (SSPPD) and antrectomy-combined pancreatoduodenectomy (ACPD), especially with respect to delayed gastric emptying (DGE) after pancreatoduodenectomy (PD). Methods: From 2002 to 2013, 628 patients who underwent SSPPD (n = 78) or ACPD (n = 550) were enrolled in this study. The rate of DGE and the nutritional status were compared between patients receiving ACPD and SSPPD. Results: The overall morbidity rate (p = 0.830) was comparable between both groups; however, the incidence of DGE grade B or C was significantly higher in the SSPPD group than that in the ACPD group (16 vs. 7%, p = 0.007). A multivariate analysis identified SSPPD rather than ACPD (p = 0.007) and portal vein resection and reconstruction (p = 0.028) to be independent risk factors for DGE grade B or C. The changes in the body weight and nutritional parameters 3, 6, and 12 months after surgery were comparable between 2 groups. Conclusions: SSPPD and not ACPD was an independent risk factor for grade B or C DGE, but the postoperative nutritional status was comparable between the 2 groups based on the limited nutritional data. Combined resection of antrum will help reduce the risk of DGE after PD.

Effect of Antecolic versus Retrocolic Gastroenteric Reconstruction after Pancreaticoduodenectomy on Delayed Gastric Emptying: A Meta-Analysis of Six Randomized Controlled Trials

Background: One of the most frequent complications of pancreaticoduodenectomy (PD) is delayed gastric emptying (DGE). The study aim was to evaluate the impact of the type of gastro/duodenojejunal reconstruction (antecolic vs. retrocolic) after PD on DGE incidence. Methods: A systematic review was made according to the PRISMA guidelines. Randomized controlled trials (RCTs) comparing antecolic vs. retrocolic reconstruction were included irrespective of the PD techniques. A meta-analysis was then performed. Results: Six RCTs were included for a total of 588 patients. The overall quality was good. General risk of bias was low. DGE was not statistically significantly different between the antecolic and retrocolic group (OR 0.6, 95% CI 0.31-1.16, p = 0.13). The other main surgery-related complications (pancreatic fistula, hemorrhage, intra-abdominal abscess, bile leak and wound infection) were not dependent on the reconstruction route (OR 0.84, 95% CI 0.41-1.70, p = 0.63). No statistically significant difference in terms of length of hospital stay was found between the 2 groups. There was also no difference of DGE incidence if only pylorus-preserving PD was considered and between the DGE grades A, B or C. Conclusion: This meta-analysis shows that antecolic reconstruction after PD is not superior to retrocolic reconstruction in terms of DGE.

Delayed Gastric Emptying (DGE) Following Total Pancreatectomy with Islet Auto Transplantation in Patients with Chronic Pancreatitis

BackgroundThe prevalence and factors associated with delayed gastric emptying (DGE) in patients undergoing total pancreatectomy with islet auto transplantation (TP-IAT) for chronic pancreatitis are unknown. MethodsA retrospective study of all patients who underwent TP-IAT at Johns Hopkins Hospital (JHH) from August 2011 to November 2014 was performed. The International Study Group of Pancreatic Surgery (ISGPS) clinical grading of DGE was used in this study. Key ResultsA total of 39 patients with chronic pancreatitis underwent TP-IAT during the study period. The prevalence of DGE following TP-IAT was 35.9 %. Twenty-five patients (64.1 %) had no DGE, 10 (25.6 %) had grade A, 2 (5.1 %) had grade B, and 2 patients (5.1 %) had grade C DGE. Patients with DGE had 5.7-fold higher odds of having a hospital length of stay (LOS) greater than 14 days (OR 5.70, 95 % CI 1.37–23.76, p = 0.02). Patients undergoing laparoscopic TP-IAT had significantly shorter LOS (10.5 vs. 14 days, p = 0.02) and lower need for prokinetics (0.01) during the postoperative course. Conclusions and InferencesDGE is common after TP-IAT and can prolong LOS. Laparoscopic TP-IAT lowers LOS and need for prokinetics postoperatively. Further studies are needed to determine if laparoscopic approaches will improve long-term dysmotility.

Primary versus secondary delayed gastric emptying (DGE) grades B and C of the International Study Group of Pancreatic Surgery after pancreatoduodenectomy: a retrospective analysis on a group of 132 patients.

Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PDD) significantly contributing to post-operative morbidity. Clinical risk factors for DGE occurrence after PDD remain controversial. From January 2004 to December 2011, a total of 132 patients underwent PDD for either malignancies (73.5%) or benign diseases (26.5%) in one single universitary center. Post-operative mortality and morbidity were, respectively, 3 and 44.7%. DGE has been defined in accordance with the International Study Group of Pancreatic Surgery (ISGPS) classification. DGE was distinguished in primary or secondary. Factors associated with grades B and C of DGE, based on severity and clinical impact, were assessed by means of univariate and multivariate analysis. Thirty-eight patients (28.8%) had clinical DGE grade B or C. Post-operative complications (pancreatic fistula and/or hemorrhage or anastomotic leak) were reported in 25 out of the 38 patients (65.8%, secondary DGE), while in 13 patients it was not associated to any other complication (34.2%, primary DGE). Post-operative complications (pancreatic fistula and hemorrhage) appeared to be the most important predictive factor for Grade B or C DGE.

The Added Value of Partial Stomach-partitioning to a Conventional Gastrojejunostomy in the Treatment of Gastric Outlet Obstruction

IntroductionPoor results have been reported after conventional gastrojejunostomy (CGJ) as palliative surgical bypass treatment of gastric outlet obstruction (GOO). Partial stomach-partitioning gastrojejunostomy (PSPGJ) has been introduced as an alternative surgical treatment of GOO to reduce the risk of postoperative delayed gastric emptying (DGE). AimThe aim was to study PSPGJ as an alternative to CGJ in the treatment of GOO, with respect to DGE. Patients and MethodsA retrospective cohort study was completed in all patients who underwent a bypass of the duodenum via PSPGJ or CGJ due to GOO. Cases where concomitant biliary or bariatric procedures were performed were excluded. ResultsTwenty-four patients met the inclusion criteria for the study; ten cases underwent PSPGJ and 14 CGJ. The incidence of DGE grade B-C was significantly lower in the PSPGJ group (0 %) compared with the CGJ group (42.9 %, p = 0.024). Oral nutrition only was recorded more often at follow-up in the PSPGJ group (9/9, 100 %) than in the CGJ group (4/13, 30.8 %) (p = 0.002). ConclusionPSPGJ seems to be followed by a lower rate of DGE compared to CGJ.

Pancreatic fistulae after a pancreatico-duodenectomy: are pancreatico-gastrostomies safer than pancreatico-jejunostomies? An expertise-based trial and propensity-score adjusted analysis

BackgroundA pancreatic fistula (PF) is a major contributor to morbidity and mortality after a pancreaticoduodenectomy (PD). There remains debate as to whether re-establishing pancreaticoenteric continuity by a pancreatico-gastrostomy (PG) can decrease the risk of a PF and complications compared with a pancreatico-jejunostomy (PJ). The outcomes of patients undergoing these reconstructions after a PD were compared. MethodPatients undergoing a PD between 1999 and 2011 were selected from a prospective database and having undergone either a PG or PJ reconstruction. A propensity-score adjusted multivariate logistic regression was performed to identify the effect of surgical technique on outcomes of PF, delayed gastric emptying (DGE) and total complications. ResultsTwenty-three out of 103 and 20 out of 103 (P = 0.49) patients had PF and 74 out of 103 and 55 out of 103 patients had all-grades DGE in the PG and PJ groups, respectively (P = 0.02). The groups did not differ with regards to Clavien–Dindo grade of complications (P = 0.29) but did differ with regards to the Comprehensive Complication Index (CCI) (38.4 versus 31.4 for PG versus PG, respectively, P = 0.02.) Propensity-score adjusted multivariate analysis showed no effect of PG on PF (P = 0.89), DGE grades B/C (P = 0.9) or CCI (P = 0.41). There remained an effect on all-grades of DGE (P = 0.012.) DiscussionPatients undergoing PG reconstruction had a similar rate of PF as those undergoing a PJ after a PD.

Value of Scintigraphy for Assessing Delayed Gastric Emptying After Pancreatic Surgery

Delayed gastric emptying (DGE) occurs frequently after pancreatic surgery. Recently a consensus definition of DGE was introduced, and this grading system is currently widely used. The aim of this study was to compare results of gastric emptying scintigraphy with the grade of DGE after pancreatic surgery. In 44 patients undergoing exploration for a pancreatic head or periampullary tumor, 28 pancreatoduodenectomies (PDs) and 16 double-bypass procedures were performed. All patients underwent preoperative and postoperative gastric emptying scintigraphy. We investigated whether the incidence of DGE was correlated with the results of gastric emptying scintigraphy. DGE occurred in 19 (43 %) patients. Clinically relevant DGE (grades B and C) prevailed in the PD group. Median postoperative residual activity at t = 2 h (%RA120) in these groups was 36 % (no DGE), 75 % (grade A), 93 % (grade B), and 95 % (grade C). DGE grade B or C was found in 7 of 10 patients with %RA120 of ≥94 % on postoperative day (POD) 7. Postoperative %RA120 on scintigraphy is positively associated with severity of DGE. Gastric emptying scintigraphy on POD 7 can predict the severity of DGE. When postoperative gastric emptying scintigraphy shows high residual radioactivity, the likelihood of further progression to grade B or C DGE is high and warrants investigation for underlying causes.

BMPR2 deletion increases susceptibility to chronic pancreatitis

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.

Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy versus pancreaticoduodenectomy in southern Chinese population

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.

Delayed Gastric Emptying After Pancreatoduodenectomy

Antecolic reconstruction after pylorus-preserving pancreatoduodenectomy (PPPD) has been reported to decrease the incidence of delayed gastric emptying (DGE), which is one of the main postoperative complications. Subtotal stomach-preserving PD (SSPPD), in which duodenum and pylorus ring were removed, was introduced for the purpose of decreasing the incidence of DGE. This prospective randomized control study was performed to assess whether antecolic reconstruction decreases the incidence of DGE compared with retrocolic reconstruction after SSPPD. Forty-six patients were enrolled in this trial between May 2007 and June 2010. Twenty-two and 24 patients were randomized for the retrocolic and antecolic groups, respectively. The primary endpoint was DGE incidence. The overall incidence of DGE in the retrocolic group was significantly higher than that in the antecolic group (50% versus 20.8%, P=0.0364). In particular, this difference was most striking in the incidence of DGE grade B/C (27.3% versus 4.2%, P=0.0234). Furthermore, patients in the retrocolic group required significantly longer time to full resumption of diet compared with the antecolic group. No significant difference was observed in other postoperative complications between the two groups. Antecolic reconstruction, and not retrocolic reconstruction, decreases DGE incidence after SSPPD.

Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors

ObjectivesThis study evaluates the incidence and clinical features and associated risk factors of delayed gastric emptying (DGE) after pancreaticoduodenectomy, employing the International Study Group of Pancreatic Surgery (ISGPS) consensus definition. MethodsDemographic, pathological and surgical details for 260 consecutive patients who underwent pylorus-preserving pancreaticoduodenectomy at a single institution were analysed using univariate and multivariate models. ResultsPostoperative complications occurred in 108 (41.5%) and DGE was diagnosed in 36 (13.8%) of 260 patients. Among the 36 DGE patients, 16 had grade A, 18 grade B and two grade C DGE. Resumption of a solid diet (P < 0.001), time to passage of stool (P= 0.002) and hospital discharge (P < 0.001) occurred later in DGE patients. The need for total parenteral nutrition was significantly higher in DGE grade B/C patients (P < 0.001). In the univariate analysis, abdominal collections (P≤ 0.001), pancreatic fistula (PF) grades B and C (P < 0.001), biliary fistula (P= 0.002), pulmonary complications (P < 0.001) and sepsis (P= 0.002) were associated with DGE. Only abdominal collections (P= 0.009), PF grade B/C (P < 0.001) and sepsis (P= 0.024) were associated with clinically relevant DGE. In the multivariate analysis, PF grade B/C (P= 0.004) and biliary fistula (P= 0.039) were independent risk factors for DGE. ConclusionsThe ISGPS classification and grading systems correlate well with the clinical course of DGE and are feasible for patient management. The principal risk factors for DGE seem to be pancreatic and biliary fistulas.

Subtotal stomach‐preserving pancreaticoduodenectomy (SSPPD) prevents postoperative delayed gastric emptying

Delayed gastric emptying (DGE) is one of main complications after pylorus-preserving pancreaticoduodenectomy (PPPD) with regional lymph node dissection (RLND). The aim of this study was to retrospectively investigate whether subtotal stomach-preserving PD (SSPPD) decreased incidence of DGE. This study included 112 consecutive patients underwent PPPD (n = 48) or SSPPD (n = 64) with/without RLND. DGE was classified into three categories (grades A, B, and C) according to the guideline proposed by the International Study Group of Pancreatic Surgery. The incidence of DGE grade B/C in SSPPD with RLND (13.0%) was lower compared with that (34.8%) in PPPD with RLND (P = 0.0326). Consequently, the mean length of postoperative hospital stay of SSPPD with RLND group was significantly shorter than that of PPPD with RLND (P = 0.0476). SSPPD could be substituted for PPPD due to decreased postoperative DGE when RLND is involved. A randomized control trial of SSPPD versus PPPD should be considered.