Clinical and surgical factors influencing delayed gastric emptying after pyloric-preserving pancreaticoduodenectomy.
OBJECTIVE
Delayed gastric emptying (DGE) is the most common and troublesome complication after pylorus-preserving pancreaticoduodenectomy (PPPD), however, definitive treatment has not yet been established. We examined the clinical and surgical factors relevant to DGE using multivariate analyses.


METHODS
Forty-four patients with PPPD were divided into two groups according to reconstructive technique: group A (25), Billroth II type with antecolic duodenojejunostomy and group B (19), Billroth-I type. Multiple clinical and surgical factors influencing DGE were evaluated by univariate and multivariate analyses.


RESULTS
The period and output of gastric aspiration were significantly reduced in group A compared with group B (a median of 3 days vs. 14 days and a mean output of 133+26mL vs. 506+80mL, respectively; p<0.0001). Re-insertion of the tube was required in 8% of group A compared with 32% of group B. A liquid or solid diet was started at medians of 8 and 14 days in group A compared with 22 and 28 days in group B (p<0.0001), respectively. Multivariate analyses disclosed that the antecolic duodenojejunostomy and major complication were two exclusive independent predictors of restoration of gastric motility.


CONCLUSIONS
Occurrence of DGE was strongly affected by reconstruction technique and major complication. Billroth II reconstruction with antecolic duodenojejunostomy seems to be a useful technique to minimize the occurrence of DGE.
Kurosaki
Isao
I
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences Niigata City, Japan.
Hatakeyama
Katsuyoshi
K
D000328:Adult; D000368:Aged; D004435:Eating / Q000502:physiology; D005260:Female; D005746:Gastric Emptying / Q000502:physiology; D018589:Gastroparesis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods*; D011708:Pylorus; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors