Is Roux Loop a Solution to Delayed Gastric Emptying Following Pancreaticoduodenectomy? A Single Institute Analysis

Overview

Journal Indian J Surg Oncol

Specialty Oncology

Date 2021 Jul 23

PMID 34295082

Authors

B R Keerthi

G N Hemanth

M S Ganesh

Amritha Prabha

I Abhinay

Affiliations

Soon will be listed here.

Abstract

Delayed gastric emptying is one of the most common complications of pancreaticoduodenectomy (PD). It almost always results in delayed oral intake, prolonged hospital stays, and a delay in initiation of vital adjuvant treatment. A few earlier studies suggested that delayed gastric emptying (DGE) rates were better with the Roux-en Y reconstruction, but Indian literature regarding this is lacking. In our institutional study, we compared the traditional single-loop reconstruction (SL group), with the Roux loop reconstruction (RY group) following a subtotal stomach-preserving pancreaticoduodenectomy (SSPPD). A retrospective comparative study was conducted between the conventional single loop and a Roux-en-Y method of reconstruction following a subtotal stomach preserving pancreaticoduodenectomy (SSPPD). Sixty-three consecutive Whipple's procedures were analyzed for multiple clinical parameters like removal of Ryles tube, tolerance of liquid diet and solid diet, delayed gastric emptying, duration of hospital stay and interval between surgery, and initiation of adjuvant treatment. Forty-one patients in the SL group were compared with 22 patients in the RY group. Ryles tube removal (POD 8.2 versus 2.25, < 0.001), initiation of liquid diet (POD 8.43 versus 2.88, < 0.001), post-operative hospital stay (13.5 days versus 9.63, < 0.001), and interval between surgery and adjuvant treatment (37.75 days versus 28.88 days, < 0.002) were all in favor of the RY group. The delayed gastric emptying was also found to be significantly better in the Roux-en-Y surgery group ( < 0.001). The Roux loop reconstruction following a stomach-preserving pancreaticoduodenectomy (SSPPD) is superior to single-loop reconstruction with respect to delayed gastric emptying. The lesser duration of hospital stay and early initiation of adjuvant therapy are an additional benefit of the Roux loop reconstruction.

References

Goei T, van Berge Henegouwen M, Slooff M, van Gulik T, Gouma D, Eddes E . Pylorus-preserving pancreatoduodenectomy: influence of a Billroth I versus a Billroth II type of reconstruction on gastric emptying. Dig Surg. 2001; 18(5):376-80. DOI: 10.1159/000050177. View

Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M . The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017; 161(3):584-591. DOI: 10.1016/j.surg.2016.11.014. View

Itoh Z, AIZAWA I, Takeuchi S, Takayanagi R . Diurnal changes in gastric motor activity in conscious dogs. Am J Dig Dis. 1977; 22(2):117-24. DOI: 10.1007/BF01072953. View

Qu H, Sun G, Zhou S, He Q . Clinical risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: a systematic review and meta-analysis. Eur J Surg Oncol. 2013; 39(3):213-23. DOI: 10.1016/j.ejso.2012.12.010. View

Wente M, Bassi C, Dervenis C, Fingerhut A, Gouma D, Izbicki J . Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007; 142(5):761-8. DOI: 10.1016/j.surg.2007.05.005. View

Wingate D . Complex clocks. Dig Dis Sci. 1983; 28(12):1133-40. DOI: 10.1007/BF01295814. View

Barakat O, Cagigas M, Bozorgui S, Ozaki C, Patrick Wood R . Proximal Roux-en-y Gastrojejunal Anastomosis with Pyloric Ring Resection Improves Gastric Emptying After Pancreaticoduodenectomy. J Gastrointest Surg. 2016; 20(5):914-23. PMC: 4850182. DOI: 10.1007/s11605-016-3091-5. View

Yang J, Wang C, Huang Q . Effect of Billroth II or Roux-en-Y Reconstruction for the Gastrojejunostomy After Pancreaticoduodenectomy: Meta-analysis of Randomized Controlled Trials. J Gastrointest Surg. 2015; 19(5):955-63. DOI: 10.1007/s11605-015-2751-1. View

Tanaka M, Sarr M . Total duodenectomy: effect on canine gastrointestinal motility. J Surg Res. 1987; 42(5):483-93. DOI: 10.1016/0022-4804(87)90022-9. View

10.

Tran K, Smeenk H, van Eijck C, Kazemier G, Hop W, Greve J . Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg. 2004; 240(5):738-45. PMC: 1356476. DOI: 10.1097/01.sla.0000143248.71964.29. View

11.

Kurosaki I, Hatakeyama K . Clinical and surgical factors influencing delayed gastric emptying after pyloric-preserving pancreaticoduodenectomy. Hepatogastroenterology. 2005; 52(61):143-8. View

12.

Murakami Y, Uemura K, Sudo T, Hayashidani Y, Hashimoto Y, Nakagawa N . An antecolic Roux-en Y type reconstruction decreased delayed gastric emptying after pylorus-preserving pancreatoduodenectomy. J Gastrointest Surg. 2008; 12(6):1081-6. DOI: 10.1007/s11605-008-0483-1. View

13.

Hartel M, Wente M, Hinz U, Kleeff J, Wagner M, Muller M . Effect of antecolic reconstruction on delayed gastric emptying after the pylorus-preserving Whipple procedure. Arch Surg. 2005; 140(11):1094-9. DOI: 10.1001/archsurg.140.11.1094. View

14.

Hansen M . Neurohumoral control of gastrointestinal motility. Physiol Res. 2003; 52(1):1-30. View

15.

Ypsilantis E, Praseedom R . Current status of fast-track recovery pathways in pancreatic surgery. JOP. 2009; 10(6):646-50. View

16.

Husebye E . The patterns of small bowel motility: physiology and implications in organic disease and functional disorders. Neurogastroenterol Motil. 1999; 11(3):141-61. DOI: 10.1046/j.1365-2982.1999.00147.x. View

17.

Sanger G, Wang Y, Hobson A, Broad J . Motilin: towards a new understanding of the gastrointestinal neuropharmacology and therapeutic use of motilin receptor agonists. Br J Pharmacol. 2012; 170(7):1323-32. PMC: 3838679. DOI: 10.1111/bph.12075. View

18.

Miedema B, Sarr M, Van Heerden J, Nagorney D, MCILRATH D, Ilstrup D . Complications following pancreaticoduodenectomy. Current management. Arch Surg. 1992; 127(8):945-9; discussion 949-50. DOI: 10.1001/archsurg.1992.01420080079012. View

19.

Tani M, Terasawa H, Kawai M, Ina S, Hirono S, Uchiyama K . Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial. Ann Surg. 2006; 243(3):316-20. PMC: 1448934. DOI: 10.1097/01.sla.0000201479.84934.ca. View

20.

Dai J, Jiang Y, Fu D . Reducing postoperative complications and improving clinical outcome: Enhanced recovery after surgery in pancreaticoduodenectomy - A retrospective cohort study. Int J Surg. 2017; 39:176-181. DOI: 10.1016/j.ijsu.2017.01.089. View