Prospective randomized clinical trial of a change in gastric emptying and nutritional status after a pylorus-preserving pancreaticoduodenectomy: comparison between an antecolic and a vertical retrocolic duodenojejunostomy

Abstract

A vertical retrocolic duodenojejunostomy was an acceptable procedure for the lower incidence of DGE and may contribute to better weight gain affected by moderate gastric emptying.

Effect of Antecolic versus Retrocolic Gastroenteric Reconstruction after Pancreaticoduodenectomy on Delayed Gastric Emptying: A Meta-Analysis of Six Randomized Controlled Trials

“…table 1; for all online suppl. material, see www.karger.com/doi/10.1159/000441480) [16,[18][19][20][21][22] . These RCTs included a total of 588 patients (296 in the antecolic group and 292 in the retrocolic group).…”

“…Imamura et al [22] conducted a RCT (Jadad score: 3) published in 2013 that compared 60 patients undergoing antecolic duodenojejunostomy with 60 patients undergoing retrocolic duodenojejunostomy. Only patients who underwent ppPD were included.…”

“…Among these 18 studies, 13 were not randomized [15,17,26,[38][39][40][41][42][43][44][45][46][47] and 4 consisted of review or meta-analysis [12,25,27,28] . The RCT by Chijiiwa et al [23] published in 2009 was excluded as it included the same patients as the study published later in 2014 by the same group [22] .…”

“…Information from one study [16] was collected via the authors; the 2 other articles were not included in the ppPD subgroup meta-analysis [18,19] . Three studies described the length of hospital stay as median and not as mean [16,20,22] . For 2 studies, the mean was obtained from the authors [16,22] .…”

“…Since the available evidence remains conflicting, there is an ongoing debate as to whether an antecolic or retrocolic (through the mesocolon) reconstruction should be favored. Some retrospective studies and randomized controlled trials (RCTs) have shown that the antecolic method is associated with fewer DGE [15,17,18,21,26] , but other studies found no difference [16,19,20,22,23] . Three specific meta-analyses were performed: two concluding that the antecolic reconstruction was superior [25,27] and one finding that there was no difference [28] .…”