Tim Fahlbusch1, Andreas Minh Luu1, Philipp Höhn1, Carsten Klinger2, Jens Werner3, Tobias Keck4, Helmut Friess5, Jörg Köninger6, Thomas Kraus7, Guido Alsfasser8, Winfried Padberg9, Jörg Peter Ritz10, Waldemar Uhl1, Orlin Belyaev1. 1. St. Josef Hospital, Department of General and Visceral Surgery, Ruhr-University Bochum, Germany. 2. Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Berlin, Germany. 3. Department of General, Visceral, and Transplant Surgery, University Hospital Munich, LMU, Munich, Germany. 4. Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany. 5. Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, TUM München, Germany. 6. Klinik für Allgemein-, Viszeral-, Thorax- und Transplantationschirurgie, Katharinenhospital, Stuttgart, Germany. 7. Allgemein-, Viszeral- und Minimalinvasive Chirurgie, Nordwestkrankenhaus Frankfurt, Frankfurt am Main, Germany. 8. Abteilung für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsmedizin Rostock, Rostock, Germany. 9. Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen Marburg, Standort Gießen, Gießen, Germany. 10. Klinik für Allgemein- und Viszeralchirurgie, Helios Kliniken Schwerin, Schwerin, Germany.
Abstract
BACKGROUND: Delayed gastric emptying (DGE) is one of the most common complications after pancreatic head resection. It leads to increased length of hospital stay, high costs for healthcare systems and reduced quality of life. The primary aim of the study was to assess the impact of pylorus preservation, respectively resection on the occurrence of DGE in patients undergoing pancreaticoduodenectomy (PD). METHODS: All cases of pylorus-resecting PD (PRPD) and pylorus-preserving PD (PPPD) entered in the StuDoQ|Pancreas nationwide registry of the German Society of General and Visceral Surgery from 01/01/2014 until 31/12/2018 including demographics, surgical techniques, histopathological and perioperative data were retrospectively analyzed. This study was approved by the ethics committee of the Ruhr-University Bochum, Germany. RESULTS: Data of 5,080 patients were enrolled. PPPD was the method of choice (70.4%). Pylorus preservation had no impact on the occurrence of DGE (20.3% vs. 21.5%, P=0.33), but further risk factors could be identified. The comparison of PPPD and PRPD groups showed statistically significant differences in the surgical approach (primary open approach, 94.8% vs. 98.0%, P<0.001), duration of surgery (326.4 vs. 352.1 minutes, P<0.001), technique of pancreatic anastomosis (pancreaticojejunostomy vs. pancreaticojejunostomy), 78.6% vs. 85.2%, P<0.001). CONCLUSIONS: Patient factors, intraoperative factors, duration of surgery and postoperative factors (postoperative pancreatic fistula, biliary leakage and other surgical complications) were identified as risk factors for DGE. Future research should focus on register-based, prospective, randomised-controlled studies such as the currently recruiting "PyloResPres trial". 2022 Gland Surgery. All rights reserved.
BACKGROUND: Delayed gastric emptying (DGE) is one of the most common complications after pancreatic head resection. It leads to increased length of hospital stay, high costs for healthcare systems and reduced quality of life. The primary aim of the study was to assess the impact of pylorus preservation, respectively resection on the occurrence of DGE in patients undergoing pancreaticoduodenectomy (PD). METHODS: All cases of pylorus-resecting PD (PRPD) and pylorus-preserving PD (PPPD) entered in the StuDoQ|Pancreas nationwide registry of the German Society of General and Visceral Surgery from 01/01/2014 until 31/12/2018 including demographics, surgical techniques, histopathological and perioperative data were retrospectively analyzed. This study was approved by the ethics committee of the Ruhr-University Bochum, Germany. RESULTS: Data of 5,080 patients were enrolled. PPPD was the method of choice (70.4%). Pylorus preservation had no impact on the occurrence of DGE (20.3% vs. 21.5%, P=0.33), but further risk factors could be identified. The comparison of PPPD and PRPD groups showed statistically significant differences in the surgical approach (primary open approach, 94.8% vs. 98.0%, P<0.001), duration of surgery (326.4 vs. 352.1 minutes, P<0.001), technique of pancreatic anastomosis (pancreaticojejunostomy vs. pancreaticojejunostomy), 78.6% vs. 85.2%, P<0.001). CONCLUSIONS: Patient factors, intraoperative factors, duration of surgery and postoperative factors (postoperative pancreatic fistula, biliary leakage and other surgical complications) were identified as risk factors for DGE. Future research should focus on register-based, prospective, randomised-controlled studies such as the currently recruiting "PyloResPres trial". 2022 Gland Surgery. All rights reserved.
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