Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial.
OBJECTIVE
To determine if an antecolic or a retrocolic duodenojejunostomy during pylorus-preserving pancreaticoduodenectomy (PpPD) was associated with the least incidence of delayed gastric emptying (DGE), in a prospective, randomized, controlled trial.


BACKGROUND
The pathogenesis of DGE after PpPD has been speculated to be related to factors such as inflammation, ischemia, gastric atony, motilin levels, and type of surgical procedure. Previous retrospective studies have shown a lower incidence of DGE after antecolic duodenojejunostomy. A prospective trial is needed.


METHODS
Forty patients were enrolled in this trial between May 2002 and April 2004. Just before duodenojejunostomy during PpPD, the patients were randomly assigned to undergo either an antecolic or a retrocolic duodenojejunostomy.


RESULTS
DGE occurred in 5% of patients with the antecolic route for duodenojejunostomy versus 50% with the retrocolic route (P = 0.0014). Those with the antecolic route had a significantly shorter duration of postoperative nasogastric tube drainage than did those with the retrocolic route (4.2 days versus 18.9 days, respectively, P = 0.047). By postoperative day 14, all patients with the antecolic route could take solid foods, while only 55% (11 of 20) of the patients with the retrocolic route could take solid foods (P = 0.0007). The length of stay in the hospital was 28 days for the antecolic group versus 48 days for the retrocolic group (P = 0.018).


CONCLUSIONS
Antecolic reconstruction for duodenojejunostomy during PpPD decreases postoperative morbidity and length of hospital stay by decreasing DGE. Our data suggest that PpPD with antecolic duodenojejunostomy is a safer operation.
Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
Masaji
M
Tani
Hiroshi
H
Terasawa
Manabu
M
Kawai
Shinomi
S
Ina
Seiko
S
Hirono
Kazuhisa
K
Uchiyama
Hiroki
H
Yamaue
D000368:Aged; D001649:Bile Duct Diseases / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies; D011708:Pylorus / Q000503:physiopathology / Q000601:surgery*; D013272:Stomach Diseases / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D016896:Treatment Outcome