TY - JOUR

T1 - Impact of the reconstruction method on delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy

T2 - a prospective randomized study

AU - Tamandl, Dietmar

AU - Sahora, Klaus

AU - Prucker, Johannes

AU - Schmid, Rainer

AU - Holst, Jens-Juul

AU - Miholic, Johannes

AU - Goetzinger, Peter

AU - Gnant, Michael

AU - Holst, Jens Juul

PY - 2014/2

Y1 - 2014/2

N2 - 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.

AB - 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.

U2 - 10.1007/s00268-013-2274-4

DO - 10.1007/s00268-013-2274-4

M3 - Journal article

C2 - 24121364

VL - 38

SP - 465

EP - 475

JO - World Journal of Surgery

JF - World Journal of Surgery

SN - 0364-2313

IS - 2

ER -