Prospective randomized controlled study of gastric emptying assessed by (13)C-acetate breath test after pylorus-preserving pancreaticoduodenectomy: comparison between antecolic and vertical retrocolic duodenojejunostomy.
OBJECTIVE
To examine whether vertical retrocolic duodenojejunostomy is superior to antecolic duodenojejunostomy with respect to gastric emptying in a prospective, randomized, controlled study of patients undergoing pylorus-preserving pancreaticoduodenectomy (PpPD).


METHODS
Thirty-five patients undergoing PpPD between March 2005 and July 2007 were enrolled in the study. All provided informed consent. During PpPD, the patients were randomly assigned to either the antecolic (antecolic group, n = 17) or vertical retrocolic route (vertical retrocolic group, n = 18) just before the reconstruction. Each patient ingested (13)C-acetate in a liquid meal before surgery and on postoperative day (POD) 30. Gastric emptying variables (Tmax, T1/2) were determined and compared between groups.


RESULTS
Clinical delayed gastric emptying, defined as an inability of patients to take in an appropriate amount of solid food orally by POD 14, was found in 1 of 17 patients (6%) in the antecolic group and in 4 of 18 patients (22%) in the vertical retrocolic group, but the difference was not significant (P = 0.34). Tmax and T1/2 on POD 30 were prolonged in both groups in comparison to preoperative levels, but no significant difference was found between the two groups. Follow-up examinations revealed that gastric emptying had recovered to the preoperative level by POD 30 in approximately 80% of the patients, regardless of the reconstruction route.


CONCLUSIONS
Vertical retrocolic duodenojejunostomy does not seem to offer an advantage with respect to gastric emptying.
Chijiiwa
Kazuo
K
Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, Kiyotake, Miyazaki, Japan. kazuochi@med.miyazaki-u.ac.jp
Imamura
Naoya
N
Ohuchida
Jiro
J
Hiyoshi
Masahide
M
Nagano
Motoaki
M
Otani
Kazuhiro
K
Kai
Masahiro
M
Kondo
Kazuhiro
K
D000368:Aged; D001944:Breath Tests / Q000379:methods*; D002247:Carbon Isotopes; D004385:Duodenostomy / Q000379:methods*; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D011708:Pylorus / Q000503:physiopathology / Q000601:surgery*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D002247:Carbon Isotopes