Therapeutic strategies for the management of delayed gastric emptying after pancreatic resection.
BACKGROUND
Delayed gastric emptying (DGE) is one of the most troublesome postoperative complications following pancreatic resection. Not only does it contribute considerably to prolonged hospitalization, but it is also associated with increased postoperative morbidity and mortality.


METHODS
We performed an electronic and manual search of the international literature for studies dealing with the treatment of DGE following pancreatic resection using the Medline database. The search items used were "delayed gastric emptying," "pancreaticoduodenectomy," "Whipple procedure," "pylorus-preserving pancreaticoduodenectomy," and "complications following pancreatic resection" in various combinations.


RESULTS
A number of studies were identified regarding possible therapeutic alternatives for the treatment of DGE. From the class of prokinetic regimens, most studies seem to support the use of erythromycin. However, its use has not gained wide acceptance. Regarding the operative technique, both standard Whipple and pylorus-preserving pancreatic resection carry similar rates of DGE. Billroth II type-like gastrointestinal reconstruction is the most widely accepted method and is associated with lower rates of DGE. Reoperations for managing severe DGE were very rarely reported.


CONCLUSIONS
The incidence of DGE in high-volume centers specialized in pancreatic surgery is well below 20%, thus following the improved rates that have been reported in the last decade regarding mortality and length of hospital stay after pancreatic surgery. DGE mandates a uniform definition and method of evaluation to achieve homogeneity among studies. Standardization of the operative technique, as well as "centralizing" pancreatic resections in high-volume centers, should aid to improve the occurrence of this bothersome postoperative complication.
Lytras
Dimitrios
D
1st Department of Surgery, Agia Olga Hospital, 3-5 Agias Olgas Street, 14233 Nea Ionia, Greece.
Paraskevas
Kosmas I
KI
Avgerinos
Costas
C
Manes
Costas
C
Touloumis
Zisis
Z
Paraskeva
Konstantina D
KD
Dervenis
Christos
C
D020117:Cisapride / Q000627:therapeutic use; D004750:Enteral Nutrition; D005746:Gastric Emptying / Q000502:physiology; D005765:Gastrointestinal Agents / Q000097:blood / Q000627:therapeutic use; D006801:Humans; D007441:Intubation, Gastrointestinal; D007582:Jejunostomy; D009037:Motilin / Q000097:blood; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control / Q000628:therapy; D011184:Postoperative Period; D013997:Time Factors
D005765:Gastrointestinal Agents; D009037:Motilin; D020117:Cisapride