Delayed Gastric Emptying after Pancreaticoduodenectomy and Pancreaticogastrostomy

Fabré, J; Burgel, J.S; Navarro, Françis; Boccarat, Gilles; Lemoine, Marie Christine; Domergue, J

doi:10.1080/110241599750006460

Cited by 49 publications

(16 citation statements)

References 16 publications

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“…Although the pathophysiologic basis of this is undermined, this is in keeping with the findings of other studies. 52,59 Post-operative complications were shown in several studies to be associated with DGE. 9,32,33,59,60 .…”

Section: Discussionmentioning

confidence: 99%

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A Reduction in Delayed Gastric Emptying by Classic Pancreaticoduodenectomy with an Antecolic Gastrojejunal Anastomosis and a Retrogastric Omental Patch

Nikfarjam

Kimchi

Gusani

et al. 2009

Journal of Gastrointestinal Surgery

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Section: Discussionmentioning

confidence: 99%

“…52,59 Post-operative complications were shown in several studies to be associated with DGE. 9,32,33,59,60 . In a study of 51 patients undergoing PPPD, DGE did not occur when there were no other complications, whereas 43% of patients with severe complications also had DGE.…”

Section: Discussionmentioning

confidence: 99%

A Reduction in Delayed Gastric Emptying by Classic Pancreaticoduodenectomy with an Antecolic Gastrojejunal Anastomosis and a Retrogastric Omental Patch

Nikfarjam

Kimchi

Gusani

et al. 2009

Journal of Gastrointestinal Surgery

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“…Although not life-threatening, and in most cases probably self-limiting, DGE causes significant morbidity due to postponed resumption of oral intake, prolonged hospital stay, and increased costs ( 7 – 10 ). Although DGE is strongly associated with intra-abdominal complications, in particular POPF ( 11 – 14 ), it is also observed in patients without these complications. The latter condition may tentatively be designated as primary DGE, in contrast to the former clinical situation which traditionally has been called secondary DGE.…”

Section: Introductionmentioning

confidence: 99%

“…The PD procedure basically comprises three different components; the removal of the pancreatic head, the duodenum, and the reconstruction gastrointestinal continuity. The latter if of course dependent on the different techniques used (e.g., distal gastrectomy or pylorus preservation) ( 11 , 14 – 19 ). In order to apply a stepwise approach to the understanding of the pathogenesis of DGE, the aim of the current study was to compare the incidences of DGE after PD, distal pancreatectomy (DP), duodenum-preserving pancreatic head resections (DPPHR), and pancreas-preserving duodenectomy (PPD).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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.

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“…Delayed gastric emptying (DGE) is a common post-operative complication of PD, occurring in 15–40% of patients [ 34 , 35 ]. Suspected causes of DGE include removal of the motilin-secreting duodenum, gastric irritation from bile, and interruption of the myoneural pathways in the bowel wall [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Reconstruction options following pancreaticoduodenectomy after Roux-en-Y gastric bypass: a systematic review

et al. 2018

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BackgroundObesity is a risk factor for pancreatic cancer which may be treated with Roux-en-Y gastric bypass and represents an increasing morbidity. Post-RYGB anatomy poses considerable challenges for reconstruction after pancreaticoduodenectomy (PD), a growing problem encountered by surgeons. We characterize specific strategies used for post-PD reconstruction in the RYGB patient.MethodsPubMed search was performed using MeSH terms “Gastric Bypass” and “Pancreaticoduodenectomy” between 2000 and 2018. Articles reporting cases of pancreaticoduodenectomy in post-RYGB patients were included and systematically reviewed for this study.ResultsThree case reports and five case series (25 patients) addressed PD after RYGB; we report one additional case. The typical post-gastric bypass PD patient is a woman in the sixth decade of life, presenting most commonly with pain (69.2%) and/or jaundice (53.8%), median 5 years after RYGB. Five post-PD reconstructive options are reported. Among these, the gastric remnant was resected in 18 cases (69.2%), with reconstruction of biliopancreatic drainage most commonly achieved using the distal jejunal segment of the pre-existing biliopancreatic limb (73.1%). Similarly, in the eight cases where the gastric remnant was spared (30.8%), drainage was most commonly performed using the distal jejunal segment of the biliopancreatic limb (50%). Among the 17 cases reporting follow-up data, median was 27 months.ConclusionReconstruction options after PD in the post-RYGB patient focus on resection or preservation gastric remnant, as well as creation of new biliopancreatic limb. Insufficient data exists to make recommendations regarding the optimal reconstruction option, yet surgeons must prepare for the possible clinical challenge. PD reconstruction post-RYGB requires evaluation through prospective studies.

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Delayed Gastric Emptying after Pancreaticoduodenectomy and Pancreaticogastrostomy

Abstract: Postoperative complication and the need for reoperation remain the most common factors linked to the development of DGE. However, in a quarter of patients DGE was not associated with any postoperative complication.

Cited by 49 publications

References 16 publications

A Reduction in Delayed Gastric Emptying by Classic Pancreaticoduodenectomy with an Antecolic Gastrojejunal Anastomosis and a Retrogastric Omental Patch

A Reduction in Delayed Gastric Emptying by Classic Pancreaticoduodenectomy with an Antecolic Gastrojejunal Anastomosis and a Retrogastric Omental Patch

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

Reconstruction options following pancreaticoduodenectomy after Roux-en-Y gastric bypass: a systematic review

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