title: Analysis of risk factors for delayed gastric emptying (DGE) after 387 pancreaticoduodenectomies with usage of 70 stapled reconstructions.
abstract: BACKGROUND
  Delayed gastric emptying (DGE) is one of the most troublesome complications after pancreaticoduodenectomy (PD).
  
  
  METHODS
  Between 2004 and 2009, 387 patients underwent PD and of these, 302 patients (78%) underwent pylorus-preserving PD. The stapled reconstruction of duodeno- or gastrojejunostomy was introduced in 2006, and 70 patients (18%) underwent stapled Roux-en-Y reconstruction. Postoperative DGE was defined based on the International Study Group on Pancreatic Surgery classification, and grade B or C DGE was considered to be clinically relevant. Risk factors for DGE were evaluated using univariate and multivariate analyses.
  
  
  RESULTS
  Four patients died in the hospital (1.0%). Postoperative DGE was found in 70 patients (18%). DGE was less frequently seen in stapled reconstruction than in hand-sewn reconstruction (7.2% vs. 21%, P < 0.001), and in single-layer anastomosis than in double-layer anastomosis (12% vs. 24%, P = 0.02). The multivariate logistic regression analysis revealed that the independent risk factors for DGE were postoperative pancreatic fistula (risk ratio [RR] 2.4, P = 0.002), hand-sewn reconstruction (RR 2.9, P = 0.03) and male (RR 2.2, P = 0.02).
  
  
  CONCLUSIONS
  The method of alimentary reconstruction affected the occurrence of DGE. The incidence of DGE was less in stapled reconstruction than in hand-sewn reconstruction.
authors.affiliation: National Cancer Center Hospital, Tokyo, Japan. yosakamo-tky@umin.ac.j.p
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Shojiro
authors.initials: S
authors.lastname: Hata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nara
authors.forename: Minoru
authors.initials: M
authors.lastname: Esaki
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sano
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimada
authors.forename: Tomoo
authors.initials: T
authors.lastname: Kosuge
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D004385:Duodenostomy / Q000009:adverse effects; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D005746:Gastric Emptying; D018589:Gastroparesis / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D017792:Surgical Stapling / Q000009:adverse effects*; D016896:Treatment Outcome