Delayed gastric emptying after pylorus preserving pancreaticoduodenectomy--does gastrointestinal reconstruction technique matter?

Mena M Hanna; Leonardo Tamariz; Rahul Gadde; Casey Allen; Danny Sleeman; Alan Livingstone; Danny Yakoub

doi:10.1016/j.amjsurg.2015.10.015

Delayed gastric emptying after pylorus preserving pancreaticoduodenectomy--does gastrointestinal reconstruction technique matter?

Am J Surg. 2016 Apr;211(4):810-9. doi: 10.1016/j.amjsurg.2015.10.015. Epub 2015 Dec 13.

Authors

Mena M Hanna¹, Leonardo Tamariz², Rahul Gadde³, Casey Allen¹, Danny Sleeman⁴, Alan Livingstone⁴, Danny Yakoub⁵

Affiliations

¹ Division of Surgical Oncology, The Dewitt Daughtry Department of Surgery, University of Miami-Miller School of Medicine, Clinical Reasearch Building, 4th Floor, 1120 NW 14th Street, Miami, FL 33136, USA.
² Department of Internal Medicine, University of Miami-Miller School of Medicine, Miami, FL, USA.
³ Division of Surgical Oncology, The Dewitt Daughtry Department of Surgery, University of Miami-Miller School of Medicine, Clinical Reasearch Building, 4th Floor, 1120 NW 14th Street, Miami, FL 33136, USA; Department of Internal Medicine, University of Miami-Miller School of Medicine, Miami, FL, USA.
⁴ Division of Surgical Oncology, The Dewitt Daughtry Department of Surgery, University of Miami-Miller School of Medicine, Clinical Reasearch Building, 4th Floor, 1120 NW 14th Street, Miami, FL 33136, USA; The Dewitt Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Clinical Reasearch Building, 4th Floor 1120 NW 14th Street, Miami, FL 33136, USA.
⁵ Division of Surgical Oncology, The Dewitt Daughtry Department of Surgery, University of Miami-Miller School of Medicine, Clinical Reasearch Building, 4th Floor, 1120 NW 14th Street, Miami, FL 33136, USA; The Dewitt Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Clinical Reasearch Building, 4th Floor 1120 NW 14th Street, Miami, FL 33136, USA. Electronic address: dyakoub@med.miami.edu.

PMID: 26792273
DOI: 10.1016/j.amjsurg.2015.10.015

Abstract

Background: The best gastrointestinal reconstruction route after pylorus preserving pancreaticoduodenectomy remains debatable. We aimed to evaluate the incidence of delayed gastric emptying (DGE) after antecolic (AC) and retrocolic (RC) duodenojejunostomy in these patients.

Data sources: Studies comparing AC to RC reconstruction after pylorus preserving pancreaticoduodenectomy were identified from literature databases (PubMed, MEDLINE, EMBASE, SCOPUS, and Cochrane). The meta-analysis included 10 studies with a total of 1,067 patients, where 504 patients underwent AC and 563 patients underwent RC reconstruction. The incidence of DGE was significantly lower with AC reconstruction in both randomized controlled trials (risk ratio = .44, confidence interval = .24 to.77, P = .005) and retrospective studies (risk ratio .21, confidence interval .14 to .30, P < .001) with less output and days of nasogastric tube use. AC reconstruction was associated with a decreased length of stay. There was no difference in operative time, blood loss, pancreatic fistula, and abdominal abscess/collections.

Conclusions: AC reconstruction seems to be associated with less DGE, with no association with pancreatic fistula or abscess formation.

Keywords: Antecolic; Delayed gastric emptying; Duodenojejunostomy; Gastrojejunostomy; Pylorus preserving pancreaticoduodenectomy; Retrocolic.

Publication types

Review

MeSH terms

Gastroparesis*
Humans
Pancreaticoduodenectomy / methods*
Postoperative Complications*
Pylorus / surgery
Risk Factors