title: Impact of the reconstruction method on delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: a prospective randomized study.
abstract: BACKGROUND
  Delayed gastric emptying (DGE) is of considerable concern in patients undergoing pylorus-preserving pancreaticoduodenectomy (PPPD). Prolonged hospital stay, increased cost, and decreased quality of life add on to interventions needed to treat DGE. This study was conducted to determine if performing duodenojejunostomy via the antecolic rather than the retrocolic route improved incidence of DGE.
  
  
  METHODS
  Patients undergoing PPPD between April 2007 and November 2009 were randomized for either antecolic or retrocolic reconstruction of the duodenojejunostomy. DGE was then assessed by clinical criteria on postoperative day (POD) 10. A paracetamol absorption test was also administered with a liquid meal, and serial plasma levels of intestinal peptides were measured.
  
  
  RESULTS
  Overall, 64 patients were amenable for analysis: 36 in the antecolic group and 28 in the retrocolic group. The incidences of DGE on POD 10 were 17.6 and 23.1 % (antecolic vs. retrocolic, respectively) (p = 0.628). The two groups did not differ in regard to their median (interquartile range) postoperative hospital length of stay [13.0 (10.0–17.5) vs. 12.5 (11.0–17.0) days; p = 0.446], time to regular diet [5 (5–7) vs. 5 (4–6) days; p = 0.353], or morbidity (52.9 vs. 50.0 %; p = 0.777). The median length of nasogastric tube decompression was similar in the two groups [4 (3–7) vs. 3 (3–5) days; p = 0.600]. Levels of paracetamol and glucagon-like peptide-1 were markedly decreased in patients with DGE.
  
  
  CONCLUSIONS
  Antecolic reconstruction after PPPD does not improve the occurrence/the incidence of DGE and is similar to retrocolic reconstruction with regard to secondary outcome parameters.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Tamandl
authors.forename: Klaus
authors.initials: K
authors.lastname: Sahora
authors.forename: Johannes
authors.initials: J
authors.lastname: Prucker
authors.forename: Rainer
authors.initials: R
authors.lastname: Schmid
authors.forename: Jens-Juul
authors.initials: JJ
authors.lastname: Holst
authors.forename: Johannes
authors.initials: J
authors.lastname: Miholic
authors.forename: Peter
authors.initials: P
authors.lastname: Goetzinger
authors.forename: Michael
authors.initials: M
authors.lastname: Gnant
mesh_terms: D000082:Acetaminophen / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000378:metabolism; D004385:Duodenostomy; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D007582:Jejunostomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011182:Postoperative Care; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen