Pylorus Resection Does Not Reduce Delayed Gastric Emptying After Partial Pancreatoduodenectomy

Abstract

German Clinical Trials Register DRKS00004191.

Does Pyloric-ring Resection in Pancreaticoduodenectomy Prevent Delayed Gastric Emptying?

“…In this present study, PRPD was significantly decreasing the DGE rate compared to PPPD (20.0% vs. 48.0%), respectively. The DGE rate in the PRPD groups was lower when compared to the results from the latest RCTs 20 (overall DGE for PRPD group=31.2%), which investigated the effect of pylorus resection to DGE outcomes. The duration of the NG tube requirement in PRPD groups was significantly shorter when compared to PPPD groups (1 day vs. 3 days).…”

“…The pathogenesis of DGE is still unclear. Many factors were reported to increase the risk of DGE, for examples general preoperative condition, body mass index 20 , obstructive jaundice, technical aspect (preservation of pylorus, ante colic gastrojejunostomy) and postoperative complications (sepsis, intraabdominal collection). There are a lot of potential, physiologic changes following PD, especially the removal of the duodenum, and alterations in the normal path of the gastrointestinal flow were considered to increase DGE.…”

“…Moreover, PRPD may preserve the motor innervation of the body of the stomach, which, along with the absence of pylorus, may precipitate gastric emptying. 11 Many retrospective studies and 3 RCTs 13,14,20 were conducted to evaluate the role of pyloric ring resection PD on DGE outcomes, but the results are still controversial. There are only 2 Japanese RCTs 13,14 that evaluated DGE, according to the ISGPS, and these results are still in controversy as well.…”

Is systematic nasogastric decompression after pancreaticoduodenectomy really necessary?

“…In fact, the most recent literature did not clearly demonstrated the potential impact of pylorus preserving PD on the incidence of delayed gastric emptying (DGE). A recent randomized controlled trial [35] comparing PD with pylorus-resecting or pyloruspreserving did not showed significant difference in DGE rate. Finally, a recent metaanalysis [36] showed superiority for pylorus-resecting pancreaticoduodenectomy regarding DGE when all studies are included.…”

<p>Effect of Rikkunshito, a Traditional Japanese Herbal Medicine, on Delayed Gastric Emptying and Oral Dietary Intake After Pancreaticoduodenectomy: A Prospective, Randomized, Single-Center, Open-Labeled Study</p>

“…In general, surgical procedures influenced DGE, indicating the superiority of pylorus resection, 7 antecolic gastrojejunostomy or duodenojejunostomy reconstruction, 8 Braun anastomosis, 9 Billroth II reconstruction 10,11 and side-to-side gastrojejunostomy. 12,13 However, recent studies including a meta-analysis reported conflicting findings, [2][3][4][14][15][16] resulting in a lack of evidencebased effective procedures that decrease DGE consistently. Few studies have focused on pharmacological treatment for DGE after PD.…”