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

Abstract

Background: The association between delayed gastric emptying (DGE) after pancreatoduodenectomy (PD) and pancreatic reconstruction technique remain unclear. The aim of this study is to investigate whether the occurrence of DGE differs between pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG). Methods: A total of 83 patients who underwent subtotal stomach-preserving pancreatoduodenectomy was retrospectively analyzed, and the factors associated with clinically relevant DGE were explored. These patients were divided into a PG group and a PJ group according to the pancreatic reconstruction. DGE occurrence and its association with intra-abdominal complications was compared between the two types of pancreatic reconstruction. Results: The overall incidence of DGE was 27.7%. Intra-abdominal complications including pancreatic fistula were strongly associated with DGE. As to the pancreatic reconstruction, DGE developed more frequently in the PG than in the PJ. In addition, DGE with intra-abdominal complications tended to be more frequent in PG, despite the fact that intra-abdominal complications occurred at a similar frequency in both groups. Conclusions: Intra-abdominal complications were strongly associated with DGE. As to the pancreatic reconstruction, DGE developed more frequently in the PG than in the PJ. We speculate that intra-abdominal complications affected patients with PG more and resulted in frequent occurrence of DGE.

Risk Factor Identification for Delayed Gastric Emptying after Distal Pancreatectomy—An Evaluation of 1688 Patients Based on the German StuDoQ|Pancreas Registry

“…After PD, it is reported to occur in up to 80% of cases [ 3 ]. It leads to higher costs for healthcare systems due to a prolonged hospital stay and a reduced quality of life [ 4 ]. Furthermore, an early initiation of an adjuvant chemotherapy might be at risk.…”

“…The most frequent complication is delayed gastric emptying (DGE), which occurs in up to 80% of cases after pancreatic head resections [ 3 ]. A lengthened hospital stay, high costs for the healthcare system, a reduced quality of life and a potential delay of an adjuvant cancer therapy may be caused by DGE [ 4 ].…”

Development of a Novel Dorsal Incision Only Invagination Type Pancreatogastrostomy (Charité-PG) Following Open Pancreaticoduodenectomy—A Single Centre Experience

“…As DGE is not life-threatening in the first place, it causes a prolonged in-hospital stay, decreases life quality and keeps patients from sufficient recovery, which may lead to issues in adjuvant treatment. It more often appears in patients with PG than in PJ, though it is seldom a primary phenomenon; however, it has a strong association to intraabdominal complications such as the appearance of abscesses and the development of POPF and PPH [22]. Omitting of an additional ventral gastrotomy may cause less irritation to gastric peristaltic.…”

Gastric stasis following pancreatoduodenal resection: terminology and prevention issues

“…Внимание исследователей к оценке влияния способа выполнения панкреатического анастомоза на гастростаз основано прежде всего на надежности анастомоза, поскольку его несостоятельность и признаки послеоперационного панкреатита очевидно ухудшают антродуоденальную моторику. Было найдено лишь одно ретроспективное исследование с небольшой выборкой (n = 83), направленное на изучение влияния варианта панкреатического анастомоза (инвагинационный панкреатогастроанастомоз и панкреатикоеюноанастомоз) на развитие гастростаза после ПДР с субтотальным сохранением желудка [37]. Частота гастростаза в группах панкреатикоеюностомии и панкреатогастроанастомоза составила 17,4 и 40,5% (p = 0,019).…”