Randomized trial of two types of gastrojejunostomy after pancreatoduodenectomy and risk of delayed gastric emptying (PAUDA trial)

Abstract

Background Delayed gastric emptying (DGE) is the most important cause of an extended hospital stay after pancreatoduodenectomy. Reports suggest that a Roux‐en‐Y gastroenteric anastomosis may have lower incidence of DGE than a Billroth II reconstruction. The primary aim of this RCT was to compare Billroth II (single loop) and Roux‐en‐Y (double loop) after pancreatoduodenectomy to determine whether Roux‐en‐Y reconstruction is associated with a lower incidence of DGE. Secondary endpoints were postoperative complications. Methods This was a randomized unblinded single‐centre trial without masked evaluation of the main outcome. Patients undergoing pancreatoduodenectomy between 2013 and 2015 were randomized to undergo one of two types of gastroenteric anastomosis for reconstruction. Results A total of 80 patients were randomized, 40 in each group. The incidence of DGE was the same in patients undergoing Billroth II or Roux‐en‐Y gastroenteric anastomosis (both 18 of 40 patients; P = 1·000). The grade of DGE was also similar in the Billroth II and Roux‐en‐Y groups (grade A, both 10 of 40; grade B, 5 of 40 versus 6 of 40; grade C, 3 of 40 versus 2 of 40; P = 0·962). The mortality rate was 3 per cent, with no significant difference between the two groups. There were no differences in the overall rate of postoperative morbidity, relaparotomy rate or duration of hospital stay. Conclusion The incidence and severity of DGE does not differ between single‐ or double‐loop gastroenteric anastomosis performed after pancreatoduodenectomy. Registration number: NCT00915863 (http://www.clinicaltrials.gov).

Comparison of surgical outcomes between isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy after pancreaticoduodenectomy: a systematic review and meta-analysis

“…Of these, 420 duplicate articles were excluded, and we retrieved the remaining 1143 studies based on their titles and abstracts. After excluding irrelevant articles for various reasons, we included a final 14 trials involving a total of 2043 patients [6,[9][10][11][12][19][20][21][22][23][24][25][26][27]. A flowchart of the literature search process is shown in Fig.…”

“…Isolated pancreaticojejunostomy, first described in 1976, was proposed to reduce complications such as POPF, based on the theory of separating bile and pancreatic enzymes [5]. In isolated gastrojejunostomy, a second loop is made to perform the gastroenteric anastomosis, which may favor digestive transit by separating the pancreatic enzymes and gastric sutures [9]. However, the debate regarding these three reconstructions is on-going.…”

Comparison of surgical outcomes between isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy after pancreaticoduodenectomy: A systematic review and meta-analysis

“…Of these, 420 duplicate articles were excluded, and we retrieved the remaining 1143 studies based on their titles and abstracts. After excluding irrelevant articles for various reasons, we included a nal 14 trials involving a total of 2043 patients [6,[9][10][11][12][19][20][21][22][23][24][25][26][27]. A owchart of the literature search process is shown in Figure 1, and the characteristics and quality evaluation of the included studies are shown in Table 1.…”

“…Isolated pancreaticojejunostomy, rst described in 1976, was proposed to reduce complications such as POPF, based on the theory of separating bile and pancreatic enzymes [5]. In isolated gastrojejunostomy, a second loop is made to perform the gastroenteric anastomosis, which may favor digestive transit by separating the pancreatic enzymes and gastric sutures [9]. However, the debate regarding these three reconstructions is on-going.…”

<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>

“…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.…”