BACKGROUND: Delayed gastric emptying (DGE) is one of the main complications after pancreaticoduodenectomy (PD). Literature review and meta-analysis were used to evaluate whether subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) may have less incidence than pylorus-preserving pancreaticoduodenectomy (PPPD). METHODS: Online search for studies comparing PPPD to SSPPD was done. Primary outcome was DGE. Quality of included studies was evaluated and heterogeneity was assessed. Relative risk (RR) and 95% confidence intervals (CI) were calculated from pooled data in RCTs and retrospective studies. RESULTS: Eight studies met our selection criteria, with a total of 663 patients undergoing pancreaticoduodenectomy; 309 underwent PPPD and 354 underwent SSPPD. Median age was 66 years. Average male/female ratio was 57 vs. 43%, respectively. There was lower incidence of DGE with SSPPD (RR 0.527; 95% CI 0.363-0.763; p < 0.001) and less nasogastric tube days with SSPPD (RR -0.544; 95% CI -876 to -0.008; p = 0.047). Operative blood loss was more in SSPPD (RR 0.285; 95% CI 0.071-0.499; p = 0.009). There was no statistical difference between the two groups regarding length of hospital stay, incidence of pancreatic fistula, abscesses, overall morbidity, or postoperative mortality. CONCLUSION: SSPPD was associated with less DGE than PPPD. Larger prospective randomized studies are needed to investigate the association of this result with other complications in more depth.
BACKGROUND: Delayed gastric emptying (DGE) is one of the main complications after pancreaticoduodenectomy (PD). Literature review and meta-analysis were used to evaluate whether subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) may have less incidence than pylorus-preserving pancreaticoduodenectomy (PPPD). METHODS: Online search for studies comparing PPPD to SSPPD was done. Primary outcome was DGE. Quality of included studies was evaluated and heterogeneity was assessed. Relative risk (RR) and 95% confidence intervals (CI) were calculated from pooled data in RCTs and retrospective studies. RESULTS: Eight studies met our selection criteria, with a total of 663 patients undergoing pancreaticoduodenectomy; 309 underwent PPPD and 354 underwent SSPPD. Median age was 66 years. Average male/female ratio was 57 vs. 43%, respectively. There was lower incidence of DGE with SSPPD (RR 0.527; 95% CI 0.363-0.763; p < 0.001) and less nasogastric tube days with SSPPD (RR -0.544; 95% CI -876 to -0.008; p = 0.047). Operative blood loss was more in SSPPD (RR 0.285; 95% CI 0.071-0.499; p = 0.009). There was no statistical difference between the two groups regarding length of hospital stay, incidence of pancreatic fistula, abscesses, overall morbidity, or postoperative mortality. CONCLUSION:SSPPD was associated with less DGE than PPPD. Larger prospective randomized studies are needed to investigate the association of this result with other complications in more depth.
Authors: Thilo Hackert; Ulf Hinz; Werner Hartwig; Oliver Strobel; Stefan Fritz; Lutz Schneider; Jens Werner; Markus W Büchler Journal: Am J Surg Date: 2013-06-24 Impact factor: 2.565
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: Ulla Klaiber; Pascal Probst; Felix J Hüttner; Thomas Bruckner; Oliver Strobel; Markus K Diener; André L Mihaljevic; Markus W Büchler; Thilo Hackert Journal: J Gastrointest Surg Date: 2019-01-22 Impact factor: 3.452
Authors: Casey J Allen; Danny Yakoub; Francisco Igor Macedo; Austin R Dosch; Jessica Brosch; Vikas Dudeja; Ronda Ayala; Nipun B Merchant Journal: Ann Surg Date: 2018-10 Impact factor: 12.969
Authors: Adeel S Khan; Greg Williams; Cheryl Woolsey; Jingxia Liu; Ryan C Fields; Majella M B Doyle; William G Hawkins; Steven M Strasberg Journal: J Am Coll Surg Date: 2017-07-04 Impact factor: 6.113