Combined Antrectomy Reduces the Incidence of Delayed Gastric Emptying after Pancreatoduodenectomy

Yamamoto, Yusuke; Ashida, Ryo; Ohgi, Katsuhisa; Sugiura, Teiichi; Okamura, Yukiyasu; Ito, Takaaki; Kato, Yoshihiro; Yamada, Minoru; Uesaka, Katsuhiko

doi:10.1159/000474957

Cited by 12 publications

(4 citation statements)

References 39 publications

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“…[ 50 ] Most studies investigating how to reduce the incidence of DGE have focused on surgical planning or styles, such as subtotal stomach-preserving PD or resection of the antrum. [ 51 , 52 ] Although PBS has not been recognized as a risk factor for postoperative DGE, the use of PBS did significantly increase the incidence of DGE in patients undergoing PD in the present meta-analysis. A possible explanation is that the occurrence of DGE is secondary to the increased complications resulting from preoperative stent placement.…”

Section: Discussionmentioning

confidence: 61%

The effect of preoperative biliary stents on outcomes after pancreaticoduodenectomy

et al. 2020

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Background: Whether biliary drainage should be performed before surgery in jaundiced patients is a topic of debate. Published studies on the effect of preoperative biliary drainage show great discrepancies in their conclusions, and the use of different drainage methods is an important factor. The aim of the present study was to investigate the effect of preoperative biliary stents (PBS) on postoperative outcomes in patients following pancreaticoduodenectomy (PD). Methods: MEDLINE, EMBASE, Science Citation Index Expanded, and the Cochrane database were searched up to October 2019 to identify all published articles related to the topic. A meta-analysis was performed to compare postoperative outcomes in patients with and without PBS. Quality assessment and data extraction from included studies were performed by 2 independent authors. Statistical analysis was performed using RevMan 5.2 software. Results: Twenty-seven studies involving 10,445 patients were included in the analysis. Biliary drainage was performed in 5769 patients (PBS group), and the remaining 4676 patients underwent PD directly (direct surgery [DS] group). Overall mortality, severe complications, abdominal hemorrhage, bile leakage, intra-abdominal abscess, and pancreatic fistula were not significantly different between the PBS and DS groups. However, overall morbidity, delayed gastric emptying, and wound infection were significantly higher in the PBS group compared to the DS group. Subgroup analysis indicated that the adverse effect of PBS on postoperative complications was more evident with increased stent proportion. Conclusions: Preoperative biliary stenting increases overall morbidity, delayed gastric emptying, and wound infection rates in patients following PD. Thus, preoperative biliary drainage via stent placement should be avoided in patients waiting for PD.

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Section: Discussionmentioning

confidence: 61%

The effect of preoperative biliary stents on outcomes after pancreaticoduodenectomy

et al. 2020

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“…After scanning abstracts and references, 1610 articles were excluded, other 32 articles were identified, and 241 articles were considered to meet the criteria for full-text assessment, of which 210 studies were excluded because they did not meet the inclusion criteria. The remaining 31 studies, including a total of 9205 people, met all rules and were included in the review 8 , 19 – 30 , 32 – 34 , 37 , 38 , 40 , 43 – 47 , 49 , 51 – 53 , 57 – 59 . The outcome of the identification and selection processes is illustrated in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

Risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: a comprehensive systematic review and meta-analysis

Dai

Peng

Wang

et al. 2023

International Journal of Surgery

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Background: Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PPPD). However, its risk factors are still unclear. This meta-analysis aimed to identify the potential risk factors of DGE among patients undergoing PD or PPPD. Materials and methods: We searched PubMed, EMBASE, Web of Science, Cochrane Library, Google Scholar, and ClinicalTrial.gov for studies that examined the clinical risk factors of DGE after PD or PPPD from inception through 31 July 2022. We pooled odds ratios (ORs) with 95% CIs using random-effects or fixed-effects models. We also performed heterogeneity, sensitivity, and publication bias analyses. Results: The study included a total of 31 research studies, which involved 9205 patients. The pooled analysis indicated that out of 16 nonsurgical-related risk factors, three risk factors were found to be associated with an increased incidence of DGE. These risk factors were older age (OR 1.37, P =0.005), preoperative biliary drainage (OR 1.34, P =0.006), and soft pancreas texture (OR 1.23, P =0.04). On the other hand, patients with dilated pancreatic duct (OR 0.59, P =0.005) had a decreased risk of DGE. Among 12 operation-related risk factors, more blood loss (OR 1.33, P =0.01), postoperative pancreatic fistula (POPF) (OR 2.09, P <0.001), intra-abdominal collection (OR 3.58, P =0.001), and intra-abdominal abscess (OR 3.06, P <0.0001) were more likely to cause DGE. However, our data also revealed 20 factors did not support stimulative factors influencing DGE. Conclusion: Age, preoperative biliary drainage, pancreas texture, pancreatic duct size, blood loss, POPF, intra-abdominal collection, and intra-abdominal abscess are significantly associated with DGE. This meta-analysis may have utility in guiding clinical practice for improvements in screening patients with a high risk of DGE and selecting appropriate treatment measures.

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“…Our standard operation was PD with antrectomy [13] using a modified Child's method, which was performed with an open technique. Wound protector usage was determined by the surgeon.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Cefazolin and Ceftriaxone as Antimicrobial Prophylaxis in Pancreatoduodenectomy with Preoperative Drainage: Incidence of Surgical Site Infection and Susceptibility of Bacteria in Bile

Soma,

Ohgi,

Kurai

et al. 2023

World j. surg.

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Background The optimal perioperative antimicrobial agent for preventing surgical site infection (SSI) in pancreatoduodenectomy (PD) with preoperative biliary drainage (PBD) remains unclear. Methods We retrospectively reviewed 288 patients who underwent PD after PBD between 2010 and 2020 at our institution. Patients were classified into two groups according to the perioperative antimicrobial agent used (cefazoline [CEZ] group [n = 108] and ceftriaxone [CTRX] group [n = 180]). The incidence of SSI, type of bacteria in intraoperative bile culture (IBC), and antimicrobial susceptibility to prophylactic antimicrobial agents were analyzed. Results The incidence of incisional SSI was significantly lower in the CTRX group than in the CEZ group (18% vs. 31%, P = 0.021), whereas the incidence of organ/space SSI in the two groups did not differ to a statistically significant extent (35% vs. 44%, P = 0.133). Gram-negative rod (GNR) bacteria in the IBC showed better antimicrobial susceptibility in the CTRX group than in the CEZ group. In multivariate analysis, antimicrobial resistance due to GNR was a significant risk factor for incisional SSI (odds ratio, 3.50; P \ 0.001). Conclusions CTRX had better antimicrobial coverage than CEZ for GNR cultured from intraoperative bile samples. In addition, CTRX provides better antimicrobial prophylaxis than CEZ against superficial SSI in patients with PD after PBD. Trial registration number This study was not a clinical trial and had no registration numbers.

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Combined Antrectomy Reduces the Incidence of Delayed Gastric Emptying after Pancreatoduodenectomy

Cited by 12 publications

References 39 publications

The effect of preoperative biliary stents on outcomes after pancreaticoduodenectomy

The effect of preoperative biliary stents on outcomes after pancreaticoduodenectomy

Risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: a comprehensive systematic review and meta-analysis

Comparison of Cefazolin and Ceftriaxone as Antimicrobial Prophylaxis in Pancreatoduodenectomy with Preoperative Drainage: Incidence of Surgical Site Infection and Susceptibility of Bacteria in Bile

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