title: Delayed gastric emptying after pylorus preserving pancreaticoduodenectomy--does gastrointestinal reconstruction technique matter?
abstract: BACKGROUND
  The best gastrointestinal reconstruction route after pylorus preserving pancreaticoduodenectomy remains debatable. We aimed to evaluate the incidence of delayed gastric emptying (DGE) after antecolic (AC) and retrocolic (RC) duodenojejunostomy in these patients.
  
  
  METHODS
  Studies comparing AC to RC reconstruction after pylorus preserving pancreaticoduodenectomy were identified from literature databases (PubMed, MEDLINE, EMBASE, SCOPUS, and Cochrane). The meta-analysis included 10 studies with a total of 1,067 patients, where 504 patients underwent AC and 563 patients underwent RC reconstruction. The incidence of DGE was significantly lower with AC reconstruction in both randomized controlled trials (risk ratio = .44, confidence interval = .24 to.77, P = .005) and retrospective studies (risk ratio .21, confidence interval .14 to .30, P < .001) with less output and days of nasogastric tube use. AC reconstruction was associated with a decreased length of stay. There was no difference in operative time, blood loss, pancreatic fistula, and abdominal abscess/collections.
  
  
  CONCLUSIONS
  AC reconstruction seems to be associated with less DGE, with no association with pancreatic fistula or abscess formation.
authors.affiliation: Division of Surgical Oncology, The Dewitt Daughtry Department of Surgery, University of Miami-Miller School of Medicine, Clinical Reasearch Building, 4th Floor, 1120 NW 14th Street, Miami, FL 33136, USA.
authors.forename: Mena M
authors.initials: MM
authors.lastname: Hanna
authors.affiliation: Department of Internal Medicine, University of Miami-Miller School of Medicine, Miami, FL, USA.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Tamariz
authors.affiliation: Division of Surgical Oncology, The Dewitt Daughtry Department of Surgery, University of Miami-Miller School of Medicine, Clinical Reasearch Building, 4th Floor, 1120 NW 14th Street, Miami, FL 33136, USA; Department of Internal Medicine, University of Miami-Miller School of Medicine, Miami, FL, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Gadde
authors.affiliation: Division of Surgical Oncology, The Dewitt Daughtry Department of Surgery, University of Miami-Miller School of Medicine, Clinical Reasearch Building, 4th Floor, 1120 NW 14th Street, Miami, FL 33136, USA.
authors.forename: Casey
authors.initials: C
authors.lastname: Allen
authors.affiliation: Division of Surgical Oncology, The Dewitt Daughtry Department of Surgery, University of Miami-Miller School of Medicine, Clinical Reasearch Building, 4th Floor, 1120 NW 14th Street, Miami, FL 33136, USA; The Dewitt Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Clinical Reasearch Building, 4th Floor 1120 NW 14th Street, Miami, FL 33136, USA.
authors.forename: Danny
authors.initials: D
authors.lastname: Sleeman
authors.affiliation: Division of Surgical Oncology, The Dewitt Daughtry Department of Surgery, University of Miami-Miller School of Medicine, Clinical Reasearch Building, 4th Floor, 1120 NW 14th Street, Miami, FL 33136, USA; The Dewitt Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Clinical Reasearch Building, 4th Floor 1120 NW 14th Street, Miami, FL 33136, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Livingstone
authors.affiliation: Division of Surgical Oncology, The Dewitt Daughtry Department of Surgery, University of Miami-Miller School of Medicine, Clinical Reasearch Building, 4th Floor, 1120 NW 14th Street, Miami, FL 33136, USA; The Dewitt Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Clinical Reasearch Building, 4th Floor 1120 NW 14th Street, Miami, FL 33136, USA. Electronic address: dyakoub@med.miami.edu.
authors.forename: Danny
authors.initials: D
authors.lastname: Yakoub
mesh_terms: D018589:Gastroparesis; D006801:Humans; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications; D011708:Pylorus / Q000601:surgery; D012307:Risk Factors
keywords: Antecolic; Delayed gastric emptying; Duodenojejunostomy; Gastrojejunostomy; Pylorus preserving pancreaticoduodenectomy; Retrocolic