title: Improvement of early delayed gastric emptying in patients with Billroth I type of reconstruction after pylorus preserving pancreatoduodenectomy.
abstract: BACKGROUND
  Early delayed gastric emptying (DGE) is the most common complication after pylorus-preserving pancreatoduodenectomy (PpPD). Recently, a vertical antecolic reconstruction for duodenojejunostomy was recommended to decrease the incidence of early DGE in patients with Billroth II-type reconstruction after PpPD. However, Billroth I-type reconstruction (B-I) after PpPD is still favored in Japan.
  
  
  METHODS
  Twelve consecutive patients with B-I were prospectively enrolled. Our technique includes an end-to-side duodenojejunostomy and alignment of the stomach contours with fixation of the greater omentum to the abdominal wall in order to promote passage from the stomach through the jejunal loop. DGE was evaluated according to the consensus definition of the International Study Group of Pancreatic Surgery (ISGPS).
  
  
  RESULTS
  DGE was absent, with the nasogastric tube removed within 3 days in all patients. Mean duration of nasogastric tube placement was 1.5 +/- 0.4 days. Mean maximum suction volume was 85 +/- 32 ml/day.
  
  
  CONCLUSIONS
  Preliminary results were encouraging simply with relief of the outflow disturbance around the duodenojejunostomy in patients with B-I after PpPD. These findings warrant further prospective randomized trials at either multiple or high-volume centers.
authors.affiliation: Department of Digestive Surgery and Surgical Oncology (Department of Surgery II), Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube, Yamaguchi, 755-8505, Japan. tommy@yamaguchi-u.ac.jp
authors.forename: Tomio
authors.initials: T
authors.lastname: Ueno
authors.forename: Motonari
authors.initials: M
authors.lastname: Takashima
authors.forename: Michihisa
authors.initials: M
authors.lastname: Iida
authors.forename: Shin
authors.initials: S
authors.lastname: Yoshida
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Suzuki
authors.forename: Masaaki
authors.initials: M
authors.lastname: Oka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods; D003138:Common Bile Duct Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying / Q000502:physiology*; D005763:Gastroenterostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D011708:Pylorus / Q000601:surgery; D012086:Reoperation; D018570:Risk Assessment; D013270:Stomach / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome