title: Delayed gastric emptying improved by straight stomach reconstruction with twisted anastomosis to the jejunum after pylorus-preserving pancreaticoduodenectomy (PPPD) in 118 consecutive patients at a single institution.
abstract: OBJECTIVE
  Delayed gastric emptying (DGE) is a leading cause of complication after pylorus-preserving pancreaticoduodenectomy (PPPD). Its incidence has been reported to range from 5 to 57%. We describe a modified reconstruction method, which resulted in a low rate of DGE.
  
  
  METHODS
  Between April 2003 and March 2008, we performed PPPD and reconstruction using an antecolic method in 118 consecutive patients. After PPPD, reconstruction was done using conventional Child procedure in 12 patients (PPPD group) and with the following modifications in the remaining 106 patients (PPPDR group): duodenojejunostomy was performed using the straight method and the jejunum was anastomosed with a 30° counterclockwise twist. We evaluated the incidence of DGE based on the grading system defined by the International Study Group of Pancreatic Surgery (ISGPS).
  
  
  RESULTS
  The PPPDR group had a lower incidence of DGE than the PPPD group (PPPD), occurring in 7 patients (7%) versus 4 patients (33%), respectively. However, the overall morbidity rates and postoperative hospital stays of the two groups did not differ significantly.
  
  
  CONCLUSIONS
  Straight stomach reconstruction with a twisted anastomosis could reduce the incidence of DGE after PPPD reconstruction.
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, 54 Shogoin Kawaharacho, Sakyo, Kyoto, 606-8507, Japan. tmasui@kuhp.kyoto-u.ac.jp
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Masui
authors.forename: Ryuchiro
authors.initials: R
authors.lastname: Doi
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Kawaguchi
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D005746:Gastric Emptying; D018589:Gastroparesis / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007583:Jejunum / Q000000981:diagnostic imaging* / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D011708:Pylorus / Q000601:surgery; D011859:Radiography; D013270:Stomach / Q000601:surgery*