title: Reduction of the Incidence of Delayed Gastric Emptying in Side-to-Side Gastrojejunostomy in Subtotal Stomach-Preserving Pancreaticoduodenectomy.
abstract: BACKGROUND
  One of the most common morbidities of pancreaticoduodenectomies is delayed gastric emptying (DGE). The recent advent of subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) attempts to lessen this troublesome complication; however, the incidence of DGE still remains to be 4.5-20%. This study aims to evaluate whether the incidence of DGE can be reduced by the side-to-side gastric greater curvature-to-jejunal anastomosis in comparison with the gastric stump-to-jejunal end-to-side anastomosis in SSPPD.
  
  
  METHODS
  Between October 2007 and September 2012, a total of 160 consecutive patients who had undergone SSPPD were analyzed retrospectively. In the first period (October 2007-March 2010), gastrojejunostomy was performed with end-to-side anastomosis in 80 patients (SSPPD-ETS group). In the second period (April 2010-September 2012), gastrojejunostomy was performed with the greater curvature side-to-jejunal side anastomosis in 80 patients (SSPPD-STS group). The postoperative data were collected prospectively in a database and reviewed retrospectively.
  
  
  RESULTS
  The incidence of DGE was 21.3% in the SSPPD-ETS group and 2.5% in the SSPPD-STS group (P = 0.0002). According to the classification of the International Study Group of Pancreatic Surgery (ISGPS), the incidence of DGE of grades A, B, and C were 5, 5, and 7 in the SSPPD-ETS group and 0, 2, and 0 in the SSPPD-STS group, respectively. The overall morbidity and postoperative hospital stay of the two groups were not significantly different.
  
  
  CONCLUSIONS
  The greater curvature side-to-side anastomosis of gastrojejunostomy is associated with a reduced incidence of DGE after SSPPD.
authors.affiliation: Department of Surgery, Teine-Keijinkai Hospital, Teine-ku, Sapporo, Japan, torunakamura@med.hokudai.ac.jp.
authors.forename: Toru
authors.initials: T
authors.lastname: Nakamura
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Ambo
authors.forename: Takehiro
authors.initials: T
authors.lastname: Noji
authors.forename: Naoya
authors.initials: N
authors.lastname: Okada
authors.forename: Minoru
authors.initials: M
authors.lastname: Takada
authors.forename: Toru
authors.initials: T
authors.lastname: Shimizu
authors.forename: On
authors.initials: O
authors.lastname: Suzuki
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Nakamura
authors.forename: Nobuichi
authors.initials: N
authors.lastname: Kashimura
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kishida
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D005746:Gastric Emptying; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000009:adverse effects; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D020127:Recovery of Function; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D013997:Time Factors