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

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2009 Jun 24

PMID 19548039

Citations 21

Authors

Mehrdad Nikfarjam

Eric T Kimchi

Niraj J Gusani

Syed M Shah

Mandeep Sehmbey

Serene Shereef

Kevin F Staveley-OCarroll

Affiliations

Soon will be listed here.

Abstract

Background: Delayed gastric emptying (DGE) continues to be a major cause of morbidity following pancreaticoduodenectomy (PD). A change in the method of reconstruction following PD was instituted in an attempt to reduce the incidence DGE.

Methods: Patients undergoing PD from January 2002 to December 2008 were reviewed and outcomes determined. Pylorus-preserving pancreaticoduodenectomy (PPPD) with a retrocolic duodenojejunal anastomosis (n = 79) or a classic PD with a retrocolic gastrojejunostomy (n = 36) was performed prior to January 2008. Thereafter, a classic PD with an antecolic gastrojejunal anastomosis and placement of a retrogastric vascular omental patch was undertaken (n = 36).

Results: A statistically significant decrease in DGE was noted in the antecolic group compared to the entire retrocolic group (14% vs 40%; p = 0.004) and compared to patients treated by classic PD with a retrocolic anastomosis alone (14% vs 39%; p = 0.016). On multivariate analysis, the only modifiable factor associated with reduced DGE was the antecolic technique with an omental patch, odds ratio (OR) 0.3 (confidence interval (CI) 0.1-0.8) p = 0.022. Male gender was associated with an increased risk of DGE with OR 2.3 (CI 1.1-4.8) p = 0.026.

Conclusion: A classic PD combined with an antecolic anastomosis and retrogastric vascular omental patch results in a significant reduction in DGE.

Citing Articles

Impact of marmara-yegen cuttıng gastrojejunostomy on delayed gastrıc emptyıng after pancreatoduodenectomy: ınıtıal results.

Atici A, Ozocak A, Kayaci A, Guclu Ozturk E, Kararmaz A, Yegen S Langenbecks Arch Surg. 2024; 409(1):291.

PMID: 39331186 DOI: 10.1007/s00423-024-03482-x.

Risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: a comprehensive systematic review and meta-analysis.

Dai S, Peng Y, Wang G, Yin L, Yan H, Xi C Int J Surg. 2023; 109(7):2096-2119.

PMID: 37073540 PMC: 10389510. DOI: 10.1097/JS9.0000000000000418.

Antecolic versus retrocolic reconstruction after partial pancreaticoduodenectomy.

Huttner F, Klotz R, Ulrich A, Buchler M, Probst P, Diener M Cochrane Database Syst Rev. 2022; 1:CD011862.

PMID: 35014692 PMC: 8750387. DOI: 10.1002/14651858.CD011862.pub3.

Antecolic reconstruction is associated with a lower incidence of delayed gastric emptying compared to retrocolic technique after Whipple or pylorus-preserving pancreaticoduodenectomy.

Qiu J, Li M, Du C Medicine (Baltimore). 2019; 98(34):e16663.

PMID: 31441841 PMC: 6716732. DOI: 10.1097/MD.0000000000016663.

Delayed Gastric Emptying in Side-to-Side Gastrojejunostomy in Pancreaticoduodenectomy: Result of a Propensity Score Matching.

Tsutaho A, Nakamura T, Asano T, Okamura K, Tsuchikawa T, Noji T J Gastrointest Surg. 2017; 21(10):1635-1642.

PMID: 28819791 DOI: 10.1007/s11605-017-3540-9.

References

Bar-Natan M, Larson G, Stephens G, Massey T . Delayed gastric emptying after gastric surgery. Am J Surg. 1996; 172(1):24-8. DOI: 10.1016/S0002-9610(96)00048-7. View

Lytras D, Paraskevas K, Avgerinos C, Manes C, Touloumis Z, Paraskeva K . Therapeutic strategies for the management of delayed gastric emptying after pancreatic resection. Langenbecks Arch Surg. 2006; 392(1):1-12. DOI: 10.1007/s00423-006-0096-7. View

DeOliveira M, Winter J, Schafer M, Cunningham S, Cameron J, Yeo C . Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006; 244(6):931-7. PMC: 1856636. DOI: 10.1097/01.sla.0000246856.03918.9a. View

Traverso L, Kozarek R . Pancreatoduodenectomy for chronic pancreatitis: anatomic selection criteria and subsequent long-term outcome analysis. Ann Surg. 1997; 226(4):429-35; discussion 435-8. PMC: 1191055. DOI: 10.1097/00000658-199710000-00004. View

Wayne M, Jorge I, Cooperman A . Alternative reconstruction after pancreaticoduodenectomy. World J Surg Oncol. 2008; 6:9. PMC: 2265718. DOI: 10.1186/1477-7819-6-9. View

Paraskevas K, Avgerinos C, Manes C, Lytras D, Dervenis C . Delayed gastric emptying is associated with pylorus-preserving but not classical Whipple pancreaticoduodenectomy: a review of the literature and critical reappraisal of the implicated pathomechanism. World J Gastroenterol. 2006; 12(37):5951-8. PMC: 4124401. DOI: 10.3748/wjg.v12.i37.5951. View

Diener M, Knaebel H, Heukaufer C, Antes G, Buchler M, Seiler C . A systematic review and meta-analysis of pylorus-preserving versus classical pancreaticoduodenectomy for surgical treatment of periampullary and pancreatic carcinoma. Ann Surg. 2007; 245(2):187-200. PMC: 1876989. DOI: 10.1097/01.sla.0000242711.74502.a9. View

Kingsnorth A, Berg J, Gray M . A novel reconstructive technique for pylorus-preserving pancreaticoduodenectomy: avoidance of early postoperative gastric stasis. Ann R Coll Surg Engl. 1993; 75(1):38-42. PMC: 2497731. View

Itani K, Coleman R, Meyers W, Akwari O . Pylorus-preserving pancreatoduodenectomy. A clinical and physiologic appraisal. Ann Surg. 1986; 204(6):655-64. PMC: 1251421. DOI: 10.1097/00000658-198612000-00007. View

10.

Pratt W, Joseph S, Callery M, Vollmer Jr C . POSSUM accurately predicts morbidity for pancreatic resection. Surgery. 2007; 143(1):8-19. DOI: 10.1016/j.surg.2007.07.035. View

11.

Cameron J, Riall T, Coleman J, Belcher K . One thousand consecutive pancreaticoduodenectomies. Ann Surg. 2006; 244(1):10-5. PMC: 1570590. DOI: 10.1097/01.sla.0000217673.04165.ea. View

12.

Patel A, Toyama M, Kusske A, Alexander P, Ashley S, Reber H . Pylorus-preserving Whipple resection for pancreatic cancer. Is it any better?. Arch Surg. 1995; 130(8):838-42; discussion 842-3. DOI: 10.1001/archsurg.1995.01430080040005. View

13.

Yeo C, Barry M, Sauter P, Sostre S, Lillemoe K, Pitt H . Erythromycin accelerates gastric emptying after pancreaticoduodenectomy. A prospective, randomized, placebo-controlled trial. Ann Surg. 1993; 218(3):229-37; discussion 237-8. PMC: 1242953. DOI: 10.1097/00000658-199309000-00002. View

14.

Fabre J, Burgel J, Navarro F, Boccarat G, Lemoine C, Domergue J . Delayed gastric emptying after pancreaticoduodenectomy and pancreaticogastrostomy. Eur J Surg. 1999; 165(6):560-5. DOI: 10.1080/110241599750006460. View

15.

Pratt W, Maithel S, Vanounou T, Huang Z, Callery M, Vollmer Jr C . Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme. Ann Surg. 2007; 245(3):443-51. PMC: 1877022. DOI: 10.1097/01.sla.0000251708.70219.d2. View

16.

Haddad O, Porcu-Buisson G, Sakr R, Guidicelli B, Letreut Y, Gamerre M . Diagnosis and management of adenocarcinoma of the ampulla of Vater during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2005; 119(2):246-9. DOI: 10.1016/j.ejogrb.2004.01.048. View

17.

Sugiyama M, Abe N, Ueki H, Masaki T, Mori T, Atomi Y . A new reconstruction method for preventing delayed gastric emptying after pylorus-preserving pancreatoduodenectomy. Am J Surg. 2004; 187(6):743-6. DOI: 10.1016/j.amjsurg.2003.10.013. View

18.

Han S, Kim S, Jang J, Park Y . A comparison of the long-term functional outcomes of standard pancreatoduodenectomy and pylorus-preserving pancreatoduodenectomy. Hepatogastroenterology. 2007; 54(78):1831-5. View

19.

Richter A, Niedergethmann M, Sturm J, Lorenz D, Post S, Trede M . Long-term results of partial pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head: 25-year experience. World J Surg. 2003; 27(3):324-9. DOI: 10.1007/s00268-002-6659-z. View

20.

Fox J, Daniel E, Jury J, Robotham H . The mechanism of motilin excitation of the canine small intestine. Life Sci. 1984; 34(10):1001-6. DOI: 10.1016/0024-3205(84)90305-9. View