BACKGROUND: Delayed gastric emptying (DGE) is one of the most troublesome complications after pancreaticoduodenectomy (PD). METHODS: Between 2004 and 2009, 387 patients underwent PD and of these, 302 patients (78%) underwent pylorus-preserving PD. The stapled reconstruction of duodeno- or gastrojejunostomy was introduced in 2006, and 70 patients (18%) underwent stapled Roux-en-Y reconstruction. Postoperative DGE was defined based on the International Study Group on Pancreatic Surgery classification, and grade B or C DGE was considered to be clinically relevant. Risk factors for DGE were evaluated using univariate and multivariate analyses. RESULTS: Four patients died in the hospital (1.0%). Postoperative DGE was found in 70 patients (18%). DGE was less frequently seen in stapled reconstruction than in hand-sewn reconstruction (7.2% vs. 21%, P < 0.001), and in single-layer anastomosis than in double-layer anastomosis (12% vs. 24%, P = 0.02). The multivariate logistic regression analysis revealed that the independent risk factors for DGE were postoperative pancreatic fistula (risk ratio [RR] 2.4, P = 0.002), hand-sewn reconstruction (RR 2.9, P = 0.03) and male (RR 2.2, P = 0.02). CONCLUSION: The method of alimentary reconstruction affected the occurrence of DGE. The incidence of DGE was less in stapled reconstruction than in hand-sewn reconstruction.
BACKGROUND: Delayed gastric emptying (DGE) is one of the most troublesome complications after pancreaticoduodenectomy (PD). METHODS: Between 2004 and 2009, 387 patients underwent PD and of these, 302 patients (78%) underwent pylorus-preserving PD. The stapled reconstruction of duodeno- or gastrojejunostomy was introduced in 2006, and 70 patients (18%) underwent stapled Roux-en-Y reconstruction. Postoperative DGE was defined based on the International Study Group on Pancreatic Surgery classification, and grade B or C DGE was considered to be clinically relevant. Risk factors for DGE were evaluated using univariate and multivariate analyses. RESULTS: Four patients died in the hospital (1.0%). Postoperative DGE was found in 70 patients (18%). DGE was less frequently seen in stapled reconstruction than in hand-sewn reconstruction (7.2% vs. 21%, P < 0.001), and in single-layer anastomosis than in double-layer anastomosis (12% vs. 24%, P = 0.02). The multivariate logistic regression analysis revealed that the independent risk factors for DGE were postoperative pancreatic fistula (risk ratio [RR] 2.4, P = 0.002), hand-sewn reconstruction (RR 2.9, P = 0.03) and male (RR 2.2, P = 0.02). CONCLUSION: The method of alimentary reconstruction affected the occurrence of DGE. The incidence of DGE was less in stapled reconstruction than in hand-sewn reconstruction.
Authors: Dong K Kim; Alexander A Hindenburg; Sushil K Sharma; Chang Ho Suk; Frank G Gress; Harry Staszewski; James H Grendell; William P Reed Journal: Ann Surg Oncol Date: 2005-03-03 Impact factor: 5.344
Authors: John W Kunstman; Annabelle L Fonseca; Maria M Ciarleglio; Xiangyu Cong; Abby Hochberg; Ronald R Salem Journal: J Gastrointest Surg Date: 2012-03-27 Impact factor: 3.452
Authors: Jamie R Robinson; Paula Marincola; Julia Shelton; Nipun B Merchant; Kamran Idrees; Alexander A Parikh Journal: HPB (Oxford) Date: 2015-02-28 Impact factor: 3.647