title: Effect of billroth II or Roux-en-Y reconstruction for the gastrojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: a randomized controlled study.
abstract: OBJECTIVE
  Delayed gastric emptying (DGE) is one of the major complications after pancreaticoduodenectomy (PD), occurring in 14% to 61% of cases. There have been no studies that compare the incidence of DGE in terms of the reconstruction method of gastrojejunostomy performed in subtotal stomach-preserving pancreaticoduodenectomy (SSPPD). The objective of this study was to evaluate the superiority of Billroth II (B-II) to Roux-en Y (R-Y) reconstruction on decreasing the incidence of delayed gastric emptying DGE after SSPPD by a prospective randomized controlled trial.
  
  
  METHODS
  Between April 2008 and August 2011, 101 patients who underwent SSPPD for pancreatic head or periampullary diseases were randomly allocated to B-II reconstruction (n = 52) and R-Y reconstruction (n = 49) groups. The primary endpoint was incidence of DGE.
  
  
  RESULTS
  DGE occurred in 5.7% of patients in the B-II group and in 20.4% of patients in the R-Y group (P = 0.028). Patients in the B-II group had a significantly shorter hospital stay after operation than patients in the R-Y group (31.6 ± 15.0 days vs. 41.4 ± 20.5 days, P = 0.037). In terms of postoperative complications, the incidence of pancreatic fistula was significantly higher in patients with DGE (38.5%) than in patients without DGE (14.8%) (P = 0.037).
  
  
  CONCLUSIONS
  It is suggested that the incidence of DGE after SSPPD can be decreased by using B-II rather than R-Y reconstruction for gastrojejunostomy.(Clinical Trials Registry, UMIN-CTR: http://www.umin.ac.jp/ctr/, ref no. UMIN000003535).
authors.affiliation: Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan. guido.torzilli@unimi.it
authors.forename: Mitsugi
authors.initials: M
authors.lastname: Shimoda
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kubota
authors.forename: Masato
authors.initials: M
authors.lastname: Katoh
authors.forename: Junji
authors.initials: J
authors.lastname: Kita
mesh_terms: D000368:Aged; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D005763:Gastroenterostomy; D018589:Gastroparesis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome