Delayed Gastric Emptying after Pancreatic Surgery: Analysis of Factors Determinant for the Short-term Outcome

Abstract

BackgroundDelayed gastric emptying (DGE) frequently complicates pancreatoduodenectomy (PD). Mainly DGE develops as consequence of postoperative intra-abdominal complications (secondary), while the incidence of primary DGE (i.e., not related to surgical complications) has rarely been studied. Moreover, the pathogenesis of DGE is complex and needs to be further elucidated. The present study aimed at highlighting potential mechanisms behind primary and above all secondary DGE by studying a variety of different pancreatic surgical procedures.Patients and methodsDuring the time period 2008–2011, 327 patients underwent pancreatic resective procedures at Karolinska University Hospital. Of these, 242 were PD and 56 tail resections, 17 had a duodenal preserving pancreatectomy for chronic pancreatitis, and 15 patients with familial duodenal polyposis had a pancreas preserving duodenectomy. All postoperative courses were assessed and scored according to Clavien–Dindo. The presence of DGE was evaluated and recorded according to the definition launched by the International Study Group for Pancreatic Surgery (ISGPS). Crude associations were studied in a univariate model, followed by a multivariate analysis of the respective factors. The associations were presented as odds ratios (ORs) with 95% confidence intervals (CIs).ResultsIn total DGE emerged during the postoperative course in about 40% of the PD cases. About half of those (n = 47) were scored as being primary. The majority of the primary DGEs were classified as A (n = 26) and only four as grade C, whereas among the secondary cases significantly more patients were scored as grade C (p < 0.01). In those submitted to a pancreatic body and tail resection 25% reported DGE. The distribution of the different grades of DGE in patients with a tail resection followed the same pattern with a predominance of Grade A cases with an equal distribution between those being scored as primary and secondary. Duodenal preservation, as well as keeping the pancreas intact following duodenectomy, was not followed by primary DGE. Multivariate risk factor analyses for the development of primary GE revealed no specific risk profile except for high age.ConclusionDGE is frequently seen after different surgical procedures directed toward the pancreatic gland. DGE is most commonly seen after PD, and half of these cases are scored as primary DGE. Primary and secondary DGE are seen in one-quarter of the cases even after pancreatic tail resection emphasizing the complex nature of the pathogenesis. Resection of the duodenum as an important mechanism behind DGE is not supported by the present results.

Delayed gastric emptying after pancreatoduodenectomy: comparison between invaginated pancreatogastrostomy and pancreatojejunostomy

“…Recent investigations have reported that DGE should be considered a warning of IACs, such as PF or IAA [6,8,[14][15][16]. In fact, DGE is most often secondary to the presence of IACs (secondary DGE), and very seldom a primary event (primary DGE) [6,7,17].…”

Gastric Electrical Stimulation Is an Effective Treatment Modality for Refractory Gastroparesis in a Postsurgical Patient with Pancreatic Cancer

“…Pancreatic leak, hemorrhage, intraabdominal abscess, and delayed gastric emptying are the most common complications of Whipple surgery. GP has emerged as the leading procedure-related morbidity [16-18]. Although there have been technical advances, there is a lack of universal standardized surgical techniques for pancreaticoduodenectomy [19].…”

Current state of minimally invasive pancreatic surgery

“…Delayed gastric emptying (DGE) and postoperative pancreatic fistula (POPF) are common complications in pancreas surgery. Although more often seen with pancreaticoduodenectomy (PD), DGE still can occur often with distal pancreatectomy 20 . In the LEOPARD‐1 trial, 14 clinically significant DGE (grade B/C) was significantly less likely to occur in the laparoscopic group, whereas the rates were similar in the LAPOP trial 18 and the DIPLOMA review 16 .…”