title: Prospective randomized clinical trial of a change in gastric emptying and nutritional status after a pylorus-preserving pancreaticoduodenectomy: comparison between an antecolic and a vertical retrocolic duodenojejunostomy.
abstract: BACKGROUND
  Although an antecolic duodenojejunostomy was reported to reduce post-operative delayed gastric emptying (DGE) compared with a retrocolic duodenojejunostomy after a pylorus-preserving pancreaticoduodenectomy (PPPD), the long-term effects of these procedures have rarely been studied. The aim of this prospective, randomized, clinical trial was to investigate the influence of the reconstruction route on post-operative gastric emptying and nutrition.
  
  
  METHODS
  Reconstruction was performed in 116 patients with an antecolic duodenojejunostomy (A group, n = 58) or a vertical retrocolic duodenojejunostomy (VR group, n = 58). Post-operative complications, including DGE, gastric emptying variables assessed by (13) C-acetate breath test and nutrition, were compared between the two groups for 1 year post-operatively.
  
  
  RESULTS
  The incidence of DGE was not significantly different between the procedures (A group: 12.1%; VR group: 20.7%, P = 0.316). At post-operative month 1, gastric emptying was prolonged in the VR versus the A group but not significantly so. At post-operative month 6, gastric emptying was accelerated significantly in the A versus the VR group. Post-operative weight recovery was significantly better in the VR versus the A group at post-operative month 12 (percentage of pre-operative weight, A group: 93.8 ± 1.2%; VR group: 98.5 ± 1.3%, P = 0.015).
  
  
  CONCLUSIONS
  A vertical retrocolic duodenojejunostomy was an acceptable procedure for the lower incidence of DGE and may contribute to better weight gain affected by moderate gastric emptying.
authors.affiliation: Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, Miyazaki, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Imamura
authors.forename: Kazuo
authors.initials: K
authors.lastname: Chijiiwa
authors.forename: Jiro
authors.initials: J
authors.lastname: Ohuchida
authors.forename: Masahide
authors.initials: M
authors.lastname: Hiyoshi
authors.forename: Motoaki
authors.initials: M
authors.lastname: Nagano
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Otani
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kondo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001944:Breath Tests; D004385:Duodenostomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005746:Gastric Emptying; D018589:Gastroparesis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D007564:Japan; D007582:Jejunostomy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome; D015430:Weight Gain