title: [Gastroenteric reconstruction route after pancreaticoduodenectomy: antecolic versus retrocolic].
abstract: BACKGROUND
  Delayed gastric emptying (DGE) is a relatively common complication after cephalic pancreaticoduodenectomy (CPD). Its origin is not very clear, and it is believed that its appearance is due to multiple factors (hormones, appearance of other complications, particularly pancreatic fistulas, and the surgical technique). Among the technical aspects associated with DGE, it has been proposed that the route of gastroenteric reconstruction (antecolic or retrocolic) could have an effect on its incidence.
  
  
  METHODS
  A systemic review was made of the literature, searching for articles that compared both reconstruction routes after CPD, finding only 11 articles: 4 randomised clinical trials, one prospective study, and 6 retrospective studies. A meta-analysis could not be performed on them, due to the large methodological differences between them.
  
  
  RESULTS
  In the 4 randomised studies, 2 were in favour of the antecolic route, and 2 did not observe any differences between either of them. The antecolic route obtained a much lower DGE rate than the retrocolic one in the only prospective study. In 4 of the retrospective studies the antecolic route obtained a very low rate. The results of both routes were similar in another 2 retrospective studies, with the retrocolic route slightly better in one of them.
  
  
  CONCLUSIONS
  Using the published literature, the gastric reconstruction route associated with less DGE after CPD cannot currently be determined.
authors: Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, Spain. jose_ramia@hotmail.com
authors: José M
authors: JM
authors: Ramia
authors: Roberto
authors: R
authors: de la Plaza
authors: José E
authors: JE
authors: Quiñones
authors: Pilar
authors: P
authors: Veguillas
authors: Farah
authors: F
authors: Adel
authors: Jorge
authors: J
authors: García-Parreño
mesh_terms: D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005746:Gastric Emptying; D006801:Humans; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D013272:Stomach Diseases / Q000209:etiology* / Q000601:surgery*