title: Delayed gastric emptying after pancreaticoduodenectomy.
abstract: Delayed gastric emptying (DGE) remains an unsolved complication after pancreaticoduodenectomy (PD) with conflicting reports of its cause. We aimed to compare the effect of surgical techniques involving the stomach in PD in lowering the risk of postoperative DGE.
  
  
  
  Online search and review of key bibliographies in PubMed, Medline, Embase, Scopus, Cochrane, and Google Scholar was performed. Studies comparing PD surgical techniques were identified. Primary outcome was postoperative DGE. Methodological quality was assessed using Strengthening the Reporting of Observational Studies in Epidemiology and Consolidated Standards of Reporting Trials. Calculated pooled relative risk and odds ratios (ORs) with the corresponding 95% confidence interval (CI) were used in the meta-analyses.
  
  
  
  Overall, 376 studies were reviewed, of which 22 studies were selected including a total of 5172 patients. The incidence of DGE was lower in antecolic compared with retrocolic gastrojejunostomy (risk ratio [RR], 0.260; CI, 0.157-0.431; P < 0.001; n = 1067 patients) and in subtotal stomach preserving PD compared with pylorus preserving PD (RR, 0.527; CI, 0.363-0.763; P < 0.001; n = 663 patients). There was no significant difference between classic PD versus pylorus preserving PD (OR, 0.64; CI, 0.40-1.00; P = 0.05; n = 1209 patients), pancreaticogastrostomy versus pancreaticojejunostomy (RR, 1.02; CI, 0.62-1.68; P = 0.94; n = 961 patients), Roux-en-Y versus Billroth II gastrojejunostomy (RR, 0.946; CI, 0.788-1.136; P = 0.5513; n = 470 patients), or minimally invasive PD versus open PD (OR, 0.99; CI, 0.62-1.56; P = 0.96; n = 802).
  
  
  
  In PD, surgical techniques using antecolic reconstruction route and subtotal stomach preserving PD seem to be associated with a lower risk of DGE. Further randomized controlled trials are necessary to evaluate these results taking other causes into consideration.
authors.affiliation: Division of Surgical Oncology at Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Mena M
authors.initials: MM
authors.lastname: Hanna
authors.affiliation: Division of Surgical Oncology at Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Rahul
authors.initials: R
authors.lastname: Gadde
authors.affiliation: Division of Surgical Oncology at Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Casey J
authors.initials: CJ
authors.lastname: Allen
authors.affiliation: Division of Surgical Oncology at Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Meizoso
authors.affiliation: Division of Surgical Oncology at Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Danny
authors.initials: D
authors.lastname: Sleeman
authors.affiliation: Division of Surgical Oncology at Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Livingstone
authors.affiliation: Division of Surgical Oncology at Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nipun
authors.initials: N
authors.lastname: Merchant
authors.affiliation: Division of Surgical Oncology at Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: dyakoub@med.miami.edu.
authors.forename: Danny
authors.initials: D
authors.lastname: Yakoub
mesh_terms: D018589:Gastroparesis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*
keywords: Antecolic; Delayed gastric emptying; Gastrojejunostomy; Minimally invasive pancreaticoduodenectomy; Pancreaticogasterostomy; Pancreaticojejunostomy; Pylorus preserving pancreaticoduodenectomy; Retrocolic; Roux-en-Y; Subtotal stomach preserving pancreaticoduodenectomy