A proposal mechanism of early delayed gastric emptying after pylorus preserving pancreatoduodenectomy.

To identify the cause of early delayed gastric emptying after pylorus preserving pancreatoduodenectomy (PPPD), we evaluated patients following PPPD and other upper gastrointestinal surgery. An acetaminophen assay was used to objectively evaluate gastric emptying. We observed transient delayed gastric emptying after PPPD in the early postoperative period. This was recognized not only in patients after PPPD but also in patients after standard pancreatoduodenectomy (STPD). The gastric emptying pattern was different between patients with partial gastrectomy and patients with STPD, despite similar reconstructions of gastroenterostomy (Billroth I type reconstruction). There was no early delayed gastric emptying in patients with Billroth II type reconstruction after PPPD or in those with preservation of the vagus nerves after cholecystectomy or transabdominal esophageal transection. We speculate that the anatomic position, namely, a transient torsion or angulation of the reconstructed alimentary tract is the main cause of early delayed gastric emptying after pancreatoduodenectomy.