Analysis of Risk Factors for Delayed Gastric Emptying (DGE) after 387 Pancreaticoduodenectomies with Usage of 70 Stapled Reconstructions

Abstract

The method of alimentary reconstruction affected the occurrence of DGE. The incidence of DGE was less in stapled reconstruction than in hand-sewn reconstruction.

Delayed Gastric Emptying After Stapled Versus Hand-Sewn Anastomosis of Duodenojejunostomy in Pylorus-Preserving Pancreaticoduodenectomy: a Randomized Controlled trial

“…However, in our previous study, we already had good reason to consider that stapled reconstruction was easier, more comfortable, and more stable than HS anastomosis on the basis of experience of performing 70 anastomoses using staplers. 10 In conclusion, the results of this RCT showed that use of a CS for duodenojejunostomy in PpPD is an acceptable option that did not increase the risk of DGE.…”

“…We hypothesized that the diversity of hand-sewn (HS) anastomosis may be associated with increased risk of DGE and previously conducted a retrospective study to compare the incidence of DGE after stapled duodenojejunostomy and gastrojejunostomy with those after HS reconstruction for pylorus-preserving PD (PpPD) or classic PD in 387 patients undergoing PD. 10 This study showed that the incidence of DGE was lower after stapled reconstruction (n=70) than that after HS reconstruction (n=317) (7.2 vs. 21 %, P<0.001) and with single-layer anastomosis than with double-layer anastomosis (12 vs. 24 %, P= 0.02). However, these results may have been biased because of the retrospective single institution nature of the study that included a variety of surgical procedures and historical changes.…”

“…The assumed incidences of grade B or C DGE after PpPD in CS and HS anastomosis were estimated to be 6 and 20 %, respectively, from an institutional review. 10 The sample size was calculated on the basis of a non-inferiority margin of 5 %, a one-sided alpha level of 0.05, and a power of 80 % and included 49 patients in each arm. Assuming a dropout rate of 2 %, a total of 100 patients were to be allocated in this trial, with a total accrual period of 2 years.…”

Predictors of Postoperative Non-Chylous Massive Discharge after Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

“…The potential causes of DGE are decreased plasma motilin concentrations induced by the duodenal resection, pylorospasm after vagotomy, and gastric dysrhythmias after intra-abdominal complications [19]. Regarding surgical procedures, antimesenteric reconstruction [19], vertical reconstruction [20], antecolic reconstruction [21], and stapled Roux-en-Y reconstruction [22] were reported to decrease the incidence of DGE. Our results demonstrated that the incidence of DGE increased significantly in the high-discharge group compared to that in the low-discharge group; however, the reasons cannot be fully explained.…”

Does Braun Anastomosis Have an Impact on the Incidence of Delayed Gastric Emptying and the Extent of Intragastric Bile Reflux Following Pancreatoduodenectomy? - A Randomized Controlled Study

“…In contrast, the incidence of DGE was significantly associated with the incidence of pancreatic fistula, which is a well-recognized risk factor of DGE [11,19] . The incidence of DGE was also associated with the small main pancreatic duct diameter, which is a major risk factor for pancreatic fistula [20] .…”