Effect of pyloric dilatation on gastric emptying after pylorus-preserving pancreaticoduodenectomy.
OBJECTIVE
Pylorus-preserving pancreaticoduodenectomy (PPPD) is the standard treatment for periampullary and pancreatic head tumors. Delayed gastric emptying (DGE) is the most common (ranging from 15-45%) but not life threatening complication and impairs patient recovery and prolongs the hospital stay after PPPD. The precise pathomechanism of DGE is still unclear. The aim of this study was to evaluate whether the method of pyloric dilatation performed at the time of PPPD could improve gastric emptying.


METHODS
Forty patients underwent PPPD for pancreatic or periampullary lesions from January 1999 to July 2004 were included in this study. In twenty patients mechanical dilatation of the pylorus after duodenal transaction was performed (PPPD+PD group) while in other twenty PPPD was not followed with pyloric dilatation (PPPD group). The incidence of DGE as well as other complications was analyzed. Delayed gastric emptying was defined as gastric stasis requiring nasogastric intubation for more than 4 postoperative days (POD), or the inability to tolerate a regular diet on the 8th POD.


RESULTS
Delayed gastric emptying occurred in seven (35%) out of the 20 patients in the PPPD group, while none of the 20 patients in the PPPD+PD group developed DGE.


CONCLUSIONS
Pyloric dilatation reduces DGE after PPPD enabling patients to return sooner to a normal diet.
Department of Abdominal Surgery, University Hospital Rijeka, Croatia.
Miljenko
M
Uravić
Marko
M
Zelić
Nenad
N
Petrošić
Vlatka Sotošek
VS
Tokmadžić
Davor
D
Stimac
Alan
A
Sustić
D000328:Adult; D000368:Aged; D004106:Dilatation; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D011708:Pylorus / Q000601:surgery*