Antecolic Versus Retrocolic Route of the Gastroenteric Anastomosis After Pancreatoduodenectomy

Eshuis, Wietse J.; Eijck, Casper H.J. van; Gerhards, Michael F.; Coene, P. P. L. O.; Hingh, Ignace H. J. T. de; Karsten, Thom M.; Bonsing, Bert A.; Gerritsen, Josephus J.; Bosscha, K.; Bilgen, Ernst Jan Spillenaar; Haverkamp, Jorien A.; Busch, Olivier R.; Gulik, Thomas M. van; Reitsma, Johannes B.; Gouma, Dirk J.

doi:10.1097/sla.0b013e3182a6f529

Cited by 101 publications

(148 citation statements)

References 53 publications

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“…Hiyoshi et al evaluated gastric emptying and nutritional status after both procedures during a 12-month period (53). In this study, gastric emptying was evaluated by 13 C-acetate breath test before and after surgery. Interestingly, gastric emptying time in the pylorus-preserving group was better preserved than in the pylorus-resecting group when compared to the preoperative function indicating faster gastrointestinal passage after pylorus resection.…”

Section: Pylorus-preserving Versus Pylorus-resecting Pdmentioning

confidence: 99%

“…Occurring in up to 61% of patients, delayed gastric emptying (DGE) is the most frequent complication after PD (13). One major argument against pylorus preservation has been the hypothesis that the pylorus plays a pivotal role in the pathophysiology of DGE as devascularization and denervation of the pylorus may result in pylorospasm (14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pylorus preservation pancreatectomy or not

Klaiber

Probst

Büchler

et al. 2017

Transl. Gastroenterol. Hepatol.

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Pancreaticoduodenectomy (PD) is the treatment of choice for various benign and malignant tumors of the pancreatic head or the periampullary region, and the only hope for cure in patients with cancer at this side. While it has been associated with high morbidity and mortality rates in the last century, its centralization in specialized institutions together with refinements in the operative technique and better management of postoperative complications have made PD a standardized, safe procedure. Besides the classic Whipple procedure including distal gastrectomy, two variations of PD with or without pylorus resection, but preservation of the entire stomach in either procedure exist today. Pylorus-preserving PD has gained wide acceptance as standard procedure and is being performed by an increasing number of pancreatic surgeons.After its oncological adequacy was questioned initially, pylorus-preserving PD was shown to be equivalent to the classic Whipple procedure regarding tumor recurrence and long-term survival. Moreover, operation time and blood loss were shown to be reduced in the pylorus-preserving procedure and benefits in nutritional status and quality of life were observed. However, preservation of the pylorus has been suggested to result in an increased incidence of postoperative delayed gastric emptying (DGE). In this context, pylorus-resecting PD has become popular especially in Japan with the aim to prevent DGE by removal of the pylorus but preservation of the stomach. In contrast to positive results from early studies, latest high-quality randomized controlled trial (RCT) data show that pylorus resection does not reduce DGE compared to the pyloruspreserving operation. Non-superiority of pylorus resection was also confirmed in current meta-analysis on this topic. This article summarizes the existing evidence on PD with or without pylorus preservation and derives recommendations for daily practice.

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Section: Pylorus-preserving Versus Pylorus-resecting Pdmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pylorus preservation pancreatectomy or not

Klaiber

Probst

Büchler

et al. 2017

Transl. Gastroenterol. Hepatol.

View full text Add to dashboard Cite

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“…table 1; for all online suppl. material, see www.karger.com/doi/10.1159/000441480) [16,[18][19][20][21][22] . These RCTs included a total of 588 patients (296 in the antecolic group and 292 in the retrocolic group).…”

Section: Included Studiesmentioning

confidence: 99%

“…Since the available evidence remains conflicting, there is an ongoing debate as to whether an antecolic or retrocolic (through the mesocolon) reconstruction should be favored. Some retrospective studies and randomized controlled trials (RCTs) have shown that the antecolic method is associated with fewer DGE [15,17,18,21,26] , but other studies found no difference [16,19,20,22,23] . Three specific meta-analyses were performed: two concluding that the antecolic reconstruction was superior [25,27] and one finding that there was no difference [28] .…”

Section: Introductionmentioning

confidence: 99%

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Effect of Antecolic versus Retrocolic Gastroenteric Reconstruction after Pancreaticoduodenectomy on Delayed Gastric Emptying: A Meta-Analysis of Six Randomized Controlled Trials

Joliat

Labgaa²,

Demartines³

et al. 2015

Dig Surg

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Background: One of the most frequent complications of pancreaticoduodenectomy (PD) is delayed gastric emptying (DGE). The study aim was to evaluate the impact of the type of gastro/duodenojejunal reconstruction (antecolic vs. retrocolic) after PD on DGE incidence. Methods: A systematic review was made according to the PRISMA guidelines. Randomized controlled trials (RCTs) comparing antecolic vs. retrocolic reconstruction were included irrespective of the PD techniques. A meta-analysis was then performed. Results: Six RCTs were included for a total of 588 patients. The overall quality was good. General risk of bias was low. DGE was not statistically significantly different between the antecolic and retrocolic group (OR 0.6, 95% CI 0.31-1.16, p = 0.13). The other main surgery-related complications (pancreatic fistula, hemorrhage, intra-abdominal abscess, bile leak and wound infection) were not dependent on the reconstruction route (OR 0.84, 95% CI 0.41-1.70, p = 0.63). No statistically significant difference in terms of length of hospital stay was found between the 2 groups. There was also no difference of DGE incidence if only pylorus-preserving PD was considered and between the DGE grades A, B or C. Conclusion: This meta-analysis shows that antecolic reconstruction after PD is not superior to retrocolic reconstruction in terms of DGE.

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Nasogastric Decompression vs No Decompression After Pancreaticoduodenectomy

et al. 2020

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IMPORTANCE Although standardization of pancreaticoduodenectomy (PD) has improved postoperative outcomes, morbidity remains high. Fast-track surgery programs appear to improve morbidity, and avoiding nasogastric tube decompression (NGTD), already outdated in most major abdominal surgery, is strongly suggested after PD by fast-track surgery programs but lacks high-level evidence, especially regarding safety.OBJECTIVE To assess in a randomized clinical trial whether the absence of systematic NGTD after PD reduces postoperative complications. DESIGN, SETTING, AND PARTICIPANTSThe IPOD study (Impact of the Absence of Nasogastric Decompression After Pancreaticoduodenectomy) was an open-label, prospective, single-center, randomized clinical trial conducted at a high-volume pancreatic surgery university hospital in France. In total, 155 patients who were 18 to 75 years of age and required PD for benign or malignant disease were screened for study eligibility. Key exclusion criteria were previous gastric or esophageal surgery and severe comorbidities. Patients were randomly assigned (1:1) to systematic NGTD or to no nasogastric decompression and were followed up until 90 days after surgery.INTERVENTIONS For patients without NGTD, the NGT was removed immediately after surgery, whereas for patients with NGTD, the NGT was removed 3 to 5 days after surgery. MAIN OUTCOMES AND MEASURESThe primary end point was the occurrence of postoperative complications grade II or higher using the Clavien-Dindo classification. The primary end point and safety were evaluated in the intent-to-treat population. RESULTSFrom January 2016 to August 2018, 125 screened patients were considered eligible for the study, and 111 were randomized to no NGTD (n = 52) or to NGTD (n = 59). No patient was lost to follow-up. The 2 groups had similar patient demographic and clinical characteristics at baseline. The median (interquartile range) age was 63.0 (57.0-66.5) years in the group with NGTD (38 [64.4%] were males) and 64.0 (58.0-68.0) years in the group without NGTD (31 [59.6%] were males). The postoperative complication rates grade II or higher were similar between the 2 groups (risk ratio, 0.99; 95% CI, 0.66-1.47; P > .99). Pulmonary complication rates (risk ratio, 0.59; 95% CI, 0.18-1.95; P = .44) and delayed gastric emptying rates (risk ratio, 1.07; 95% CI, 0.52-2.21; P > .99) were not significantly different between the groups. Median (interquartile) length of hospital stay for patients without NGTD was not significantly different compared with those with NGTD

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Antecolic Versus Retrocolic Route of the Gastroenteric Anastomosis After Pancreatoduodenectomy

Cited by 101 publications

References 53 publications

Pylorus preservation pancreatectomy or not

Pylorus preservation pancreatectomy or not

Effect of Antecolic versus Retrocolic Gastroenteric Reconstruction after Pancreaticoduodenectomy on Delayed Gastric Emptying: A Meta-Analysis of Six Randomized Controlled Trials

Nasogastric Decompression vs No Decompression After Pancreaticoduodenectomy

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