BACKGROUND: Reflux esophagitis is a common complication following a distal gastrectomy. Increasingly, Roux-en-Y reconstruction has been used to prevent reflux esophagitis; however, marginal ulcer is a concern in patients with a Roux-en-Y reconstruction after distal gastrectomy. The effect of Roux-en-Y reconstruction on the development of reflux esophagitis and marginal ulcer after pancreaticoduodenectomy (PD) has not been studied. METHODS: We retrospectively studied both reflux esophagitis and marginal ulcer after 371 PDs and analyzed the association with different methods of gastrointestinal reconstruction. RESULTS: In a median follow-up time of 20 months, 40 (10.8%) of the 371 patients developed reflux esophagitis, 15 after 158 standard PD, and 25 after 213 pylorus-preserving pancreaticoduodenectomy (PPPD; P = 0.62). Cox regression model showed Roux-en-Y reconstruction was significantly inversely related to occurrence of reflux esophagitis in 158 patients after standard PD (P = 0.04) but not in 213 patients after PPPD (P = 0.24). Thirty-five of 371 studied patients developed marginal ulcer, 15 after standard PD and 20 after PPPD (P = 0.45). Multivariate analysis showed that Roux-en-Y reconstruction was the only significant predictor for marginal ulcer after PD (P = 0.02). CONCLUSIONS: Our data support the use of Roux-en-Y reconstruction after standard PD but not after PPPD.
BACKGROUND:Reflux esophagitis is a common complication following a distal gastrectomy. Increasingly, Roux-en-Y reconstruction has been used to prevent reflux esophagitis; however, marginal ulcer is a concern in patients with a Roux-en-Y reconstruction after distal gastrectomy. The effect of Roux-en-Y reconstruction on the development of reflux esophagitis and marginal ulcer after pancreaticoduodenectomy (PD) has not been studied. METHODS: We retrospectively studied both reflux esophagitis and marginal ulcer after 371 PDs and analyzed the association with different methods of gastrointestinal reconstruction. RESULTS: In a median follow-up time of 20 months, 40 (10.8%) of the 371 patients developed reflux esophagitis, 15 after 158 standard PD, and 25 after 213 pylorus-preserving pancreaticoduodenectomy (PPPD; P = 0.62). Cox regression model showed Roux-en-Y reconstruction was significantly inversely related to occurrence of reflux esophagitis in 158 patients after standard PD (P = 0.04) but not in 213 patients after PPPD (P = 0.24). Thirty-five of 371 studied patients developed marginal ulcer, 15 after standard PD and 20 after PPPD (P = 0.45). Multivariate analysis showed that Roux-en-Y reconstruction was the only significant predictor for marginal ulcer after PD (P = 0.02). CONCLUSIONS: Our data support the use of Roux-en-Y reconstruction after standard PD but not after PPPD.
Authors: Steven N Hochwald; Stephen R Grobmyer; Alan W Hemming; Eleanor Curran; David A Bloom; Matthew Delano; Kevin E Behrns; Edward M Copeland; Stephen B Vogel Journal: J Surg Oncol Date: 2010-04-01 Impact factor: 3.454
Authors: James R Butler; Tyrone Rogers; George Eckart; Gregory R Martens; Eugene P Ceppa; Michael G House; Attila Nakeeb; C Max Schmidt; Nicholas J Zyromski Journal: J Gastrointest Surg Date: 2015-02-18 Impact factor: 3.452
Authors: Andreas Minh Luu; Sina Rabea Vogel; Chris Braumann; Michael Praktiknjo; Philipp Höhn; Sarah Förster; Monika Janot; Waldemar Uhl; Orlin Belyaev Journal: Gland Surg Date: 2021-02