Delayed gastric emptying following pancreatoduodenectomy with alimentary reconstruction according to Roux-en-Y or Billroth-II

Abstract

BackgroundDelayed gastric emptying (DGE) remains the most frequent complication following pancreatoduodenectomy (PD) with published incidences as high as 61%. The present study investigates the impact of bowel reconstruction techniques on DGE following classic PD (Whipple-Kausch procedure) with pancreatogastrostomy (PG).MethodsWe included 168 consecutive patients who underwent PD with PG with either Billroth II type (BII, n = 78) or Roux-en-Y type reconstruction (ReY, n = 90) between 2004 and 2015. Excluded were patients with conventional single loop reconstruction after pylorus preserving procedures. DGE was classified according to the 2007 International Study Group of Pancreatic Surgery definition. Patients were analyzed regarding severity of DGE, morbidity and mortality, length of hospital stay and demographic factors.ResultsNo difference was observed between BII and ReY regarding frequency of DGE. Overall rate for clinically relevant DGE was 30% (ReY) and 26% (BII). BII and ReY did not differ in terms of demographics, morbidity or mortality. DGE significantly prolongs ICU (four vs. two days) and hospital stay (20.5 vs. 14.5 days). Risk factors for DGE development are advanced age, retrocolic reconstruction, postoperative hemorrhage and major complications.ConclusionsThe occurrence of DGE can not be influenced by the type of alimentary reconstruction (ReY vs. BII) following classic PD with PG. Old age and major complications could be identified as important risk factors in multivariate analysis.Trial registrationGerman Clinical Trials Register (DRKS) DRKS00011860. Registered 14 March 2017.

Varianten der retrokolischen Rekonstruktion nach partieller Pankreatoduodenektomie und deren Einfluss auf die Magenentleerung – infra- oder suprakolisch

“…Das Auftreten von Erbrechen und die Anwendung prokinetischer Substanzen war in beiden Gruppen gleich verteilt. Trat eine MES auf, so verlängerten sich sowohl die Dauer des Intensivaufenthaltes (3 [1-4,75] vs. 2 [1][2][3] Tage, p = 0,007) als auch die Dauer des Gesamtkrankenhausaufenthaltes (22 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]75] vs. 18 [14][15][16][17][18][19][20][21][22] Tage, p = 0,001) signifikant. Ein präoperativ vorbestehender Diabetes mellitus war ein Risikofaktor für eine MES (p = 0,047), außerdem zeigten sich weniger MES, wenn Somatostatinanaloga (SA) verabreicht wurden (MES55 % ohne SA, 36 % mit SA, p = 0,034).…”

Effect of Billroth‐II versus Roux‐en‐Y reconstruction for gastrojejunostomy after pancreaticoduodenectomy on delayed gastric emptying: A meta‐analysis of randomized controlled trials

“…8 Other factors include disruption of vagal innervation, pylorospasm as a consequence of pyloric devascularization after pyloric-preserving pancreaticoduodenectomy (PPPD), 9 the extent of gastrectomy, 10 or the methods of reconstruction for alimentary tract. 11,12 In addition, intra-abdominal abscess, peripancreatic collections or pancreatic fistula were speculated to be the predisposing factors of secondary DGE. 13 Consequently, multiple efforts have been advocated to prevent DGE after PD.…”

“…Decreased plasma motilin level after resection of the gastric antrum and duodenum is believed to contribute to DGE because within these structures exist high levels of motilin secretion endocrine cells 8 . Other factors include disruption of vagal innervation, pylorospasm as a consequence of pyloric devascularization after pyloric‐preserving pancreaticoduodenectomy (PPPD), 9 the extent of gastrectomy, 10 or the methods of reconstruction for alimentary tract 11,12 . In addition, intra‐abdominal abscess, peripancreatic collections or pancreatic fistula were speculated to be the predisposing factors of secondary DGE 13 …”

<p>Effect of Rikkunshito, a Traditional Japanese Herbal Medicine, on Delayed Gastric Emptying and Oral Dietary Intake After Pancreaticoduodenectomy: A Prospective, Randomized, Single-Center, Open-Labeled Study</p>

“…Effective treatments for early recovery of oral dietary intake are lacking, resulting in prolonged hospital stay and interval before the induction of adjuvant therapy. 1,2 The incidence of DGE after PD varies from 4.5% to 100% across studies, 3,4 implying difficulties in defining diagnostic criteria and incomplete understanding of its pathophysiology. We previously traced oral dietary intake after PD in detail to clarify the impact on the diagnosis of DGE and short-term postoperative outcomes.…”

“…In general, surgical procedures influenced DGE, indicating the superiority of pylorus resection, 7 antecolic gastrojejunostomy or duodenojejunostomy reconstruction, 8 Braun anastomosis, 9 Billroth II reconstruction 10,11 and side-to-side gastrojejunostomy. 12,13 However, recent studies including a meta-analysis reported conflicting findings, [2][3][4][14][15][16] resulting in a lack of evidencebased effective procedures that decrease DGE consistently. Few studies have focused on pharmacological treatment for DGE after PD.…”