Factors influencing delayed gastric emptying after pylorus-preserving pancreatoduodenectomy.
BACKGROUND
Delayed gastric emptying (DGE) is the most frequent postoperative complication after pylorus-preserving pancreatoduodenectomy (PPPD). This study was undertaken to determine which factors influence the development of DGE after PPPD.


METHODS
We studied 150 consecutive patients who underwent PPPD performed by one surgeon between 1996 and 2000. The variables analyzed were age, gender, diagnosis, laboratory data, operative time, transfusion, preoperative cholangitis, and complications. The operative factors included were route of the afferent jejunal limb (retromesenteric versus antemesenteric), type of pancreatoenteric anastomosis, and preservation of the right gastric artery. DGE was defined as nasogastric drainage for more than 10 days or delay of regular diet until 14 days postoperatively.


RESULTS
Univariate analysis showed preoperative cholangitis, intraabdominal complication, and the jejunal reconstruction method were significantly associated with DGE. Preservation of the right gastric artery was not associated with gastric emptying ability. Multivariate analysis by logistic regression showed that DGE was significantly more frequent among patients with preoperative cholangitis (15 of 36 [41.7%] versus 19 of 114 [16.7%], p=0.0031), postoperative intraabdominal complications (15 of 36 [41.7%] versus 10 of 114 [8.8%], p = 0.0001), and in the retromesenteric group (33 of 104 [31.7%] versus 3 of 46 [6.5%], p = 0.0174).


CONCLUSIONS
Preoperative cholangitis and postoperative leakage problems affect gastric emptying after PPPD during the early postoperative period. The retromesenteric route is not recommended for pancreato- and biliary-enteric anastomosis. We speculate that retromesenteric passage of afferent jejunum can cause venous congestion and bowel edema, which can in turn retard the recovery of jejunal peristalsis at the duodenojejunostomy site resulting in disturbance from food passage.
Park
Yoon-Chan
YC
Department of Surgery, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, South Korea.
Kim
Sun-Whe
SW
Jang
Jin-Young
JY
Ahn
Young Joon
YJ
Park
Yong-Hyun
YH
D000368:Aged; D000704:Analysis of Variance; D001663:Bilirubin / Q000097:blood; D002761:Cholangitis / Q000150:complications; D004066:Digestive System Diseases / Q000097:blood / Q000601:surgery; D005260:Female; D005746:Gastric Emptying; D005774:Gastrostomy / Q000009:adverse effects; D006400:Hematocrit; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D010193:Pancreaticojejunostomy / Q000009:adverse effects; D018579:Patient Selection; D011708:Pylorus / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D013997:Time Factors; D016896:Treatment Outcome
D012709:Serum Albumin; D001663:Bilirubin