title: Delayed gastric emptying after pancreaticoduodenectomy: influence of the orthotopic technique of reconstruction and intestinal motilin receptor expression.
abstract: BACKGROUND
  Delayed gastric emptying (DGE) is still a common postoperative complication after pancreaticoduodenectomy (PD). Because different reconstruction techniques after PD and the influence of motilin receptor expression are controversially discussed, the present study analyzed the influence of a total orthotopic reconstruction technique on DGE after PD.
  
  
  METHODS
  Data from patients undergoing PD and reconstruction using a total orthotopic technique were reviewed, and correlations between DGE and clinico-pathological variables were analyzed. Motilin receptor expression was measured within the duodenum, jejunum, and terminal ileum.
  
  
  RESULTS
  Three hundred seven patients received orthotopic reconstruction using a single jejunal loop. DGE grade B or C could be observed in 16.6% of the patients. DGE was significantly associated with the severity of a postoperative pancreatic fistula, the need for a reoperation, wound infections, and vascular complications. Furthermore, these parameters correlated significantly with the grade of DGE. The density of motilin receptor expression decreased significantly behind the duodenum in aboral direction.
  
  
  CONCLUSIONS
  The orthotopic reconstruction after PD is the shortest distance without resection of a jejunal segment, preserves the greatest length of jejunum and thus the highest density of motilin receptors, and should therefore be recommended to reduce the incidence of DGE after PD.
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, 66421 Homburg/Saar, Germany. otto.kollmar@uniklinikum-saarland.de
authors.forename: Otto
authors.initials: O
authors.lastname: Kollmar
authors.forename: Jens
authors.initials: J
authors.lastname: Sperling
authors.forename: Mohammed Reza
authors.initials: MR
authors.lastname: Moussavian
authors.forename: Darius
authors.initials: D
authors.lastname: Kubulus
authors.forename: Sven
authors.initials: S
authors.lastname: Richter
authors.forename: Martin Karl
authors.initials: MK
authors.lastname: Schilling
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying / Q000502:physiology*; D018589:Gastroparesis / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D007150:Immunohistochemistry; D007583:Jejunum / Q000378:metabolism* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D011446:Prospective Studies; D011964:Receptors, Gastrointestinal Hormone / Q000096:biosynthesis*; D018013:Receptors, Neuropeptide / Q000096:biosynthesis*; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods
chemical_list: D015415:Biomarkers; D011964:Receptors, Gastrointestinal Hormone; D018013:Receptors, Neuropeptide; C050802:motilin receptor