Delayed Gastric Emptying After Standard Pancreaticoduodenectomy Versus Pylorus-Preserving Pancreaticoduodenectomy: An analysis of 200 Consecutive Patients

Henegouwen, Mark I. van Berge

doi:10.1016/s1072-7515(97)00078-1

Cited by 179 publications

(132 citation statements)

References 17 publications

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“…(2) According to the second definition, DGE occurs when nasogastric intubation is required ≥10 days following the operation or is reinserted due to vomiting. (3) According to the third definition, DGE occurs when nasogastric intubation is required ≥10 days following the procedure or when a solid diet cannot be tolerated on or before the 14th post-operative day [16][17][18]. Independent of the correct definition, DGE not only leads to repeated episodes of nausea and vomiting but also has an impact on post-operative weight gain, duration of hospitalization and related morbidity, while it may also lead to fatal aspiration and pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Preventing Delayed Gastric Emptying After Whipple's Procedure—Isolated Roux Loop Reconstruction With Pancreaticogastrostomy

et al. 2013

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Although delayed gastric emptying (DGE) after Whipple's pancreaticoduodenectomy is not life-threatening and can be treated conservatively, it results in discomfort and significant prolongation of the hospital stay and adds on to the hospital costs. To overcome this problem, we started using the isolated loop technique of reconstruction along with pancreaticogastrostomy and we present our series using this technique. All consecutive patients undergoing Whipple's pancreaticoduodenectomy in a single surgical unit from January 2009 until December 2012 were included. In the absence of hepatic and peritoneal metastasis, resection (Whipple's procedure) with curative intent was done using isolated loop technique with pancreaticogastrostomy. Delayed gastric emptying was assessed clinically and on oral gastrograffin study. Bile reflux was also assessed on clinical parameters and evidence of beefy friable gastric mucosa on upper GI endoscopy and presence of reflux on hepatobiliary scintigraphy. A total of 52 patients were operated using this technique from January 2009 to October 2012. The mean operative time was 260.8±50.3, and the mean operative blood loss was 1,068.0±606.1 ml. Mean gastric emptying time 106.0±6.1 min (89-258 min). Three out of the 52(5.7 %) patients had persistent vomiting in the post-operative period requiring reinsertion of NG tube. A HIDA scan done on POD7 for all patients did not show any evidence of bile reflux in any of the patients. Pancreatogastrostomy with isolated loop in pancreaticoduodenal resection markedly reduces the post-operative incidence of alkaline reflux gastritis and DGE.

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Section: Discussionmentioning

confidence: 99%

Preventing Delayed Gastric Emptying After Whipple's Procedure—Isolated Roux Loop Reconstruction With Pancreaticogastrostomy

et al. 2013

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“…When comparing pylorus-preserving PD and classic Whipple procedure with regard to postoperative morbidity and survival, results from non-randomized studies are highly inconclusive (24)(25)(26)(27)(28)(29)(30). With the growing recognition of evidence-based surgery, randomized controlled trials (RCTs) comparing both procedures emerged, followed by systematic reviews and meta-analyses summarizing the existing literature (31)(32)(33).…”

Section: Postoperative Morbidity Mortality and Survivalmentioning

confidence: 99%

Pylorus preservation pancreatectomy or not

Klaiber

Probst

Büchler

et al. 2017

Transl. Gastroenterol. Hepatol.

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Pancreaticoduodenectomy (PD) is the treatment of choice for various benign and malignant tumors of the pancreatic head or the periampullary region, and the only hope for cure in patients with cancer at this side. While it has been associated with high morbidity and mortality rates in the last century, its centralization in specialized institutions together with refinements in the operative technique and better management of postoperative complications have made PD a standardized, safe procedure. Besides the classic Whipple procedure including distal gastrectomy, two variations of PD with or without pylorus resection, but preservation of the entire stomach in either procedure exist today. Pylorus-preserving PD has gained wide acceptance as standard procedure and is being performed by an increasing number of pancreatic surgeons.After its oncological adequacy was questioned initially, pylorus-preserving PD was shown to be equivalent to the classic Whipple procedure regarding tumor recurrence and long-term survival. Moreover, operation time and blood loss were shown to be reduced in the pylorus-preserving procedure and benefits in nutritional status and quality of life were observed. However, preservation of the pylorus has been suggested to result in an increased incidence of postoperative delayed gastric emptying (DGE). In this context, pylorus-resecting PD has become popular especially in Japan with the aim to prevent DGE by removal of the pylorus but preservation of the stomach. In contrast to positive results from early studies, latest high-quality randomized controlled trial (RCT) data show that pylorus resection does not reduce DGE compared to the pyloruspreserving operation. Non-superiority of pylorus resection was also confirmed in current meta-analysis on this topic. This article summarizes the existing evidence on PD with or without pylorus preservation and derives recommendations for daily practice.

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“…Delayed gastric emptying was successfully treated with prolonged nasogastric tube and oral erythromycin in 3 cases. 20,21 In our series, ampulla of Vater malignancy had better survival (24 months) compared to pancreas-head malignancy. This fact is in line with those that were reported in other studies.…”

Section: Discussionmentioning

confidence: 55%

Pancreaticoduodenectomy for periampullary tumors at Dr. Cipto Mangunkusumo Hospital, Jakarta

Lalisang¹,

Simanjuntak²,

Philippi³

2004

Med J Indones

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Delayed Gastric Emptying After Standard Pancreaticoduodenectomy Versus Pylorus-Preserving Pancreaticoduodenectomy: An analysis of 200 Consecutive Patients

Cited by 179 publications

References 17 publications

Preventing Delayed Gastric Emptying After Whipple's Procedure—Isolated Roux Loop Reconstruction With Pancreaticogastrostomy

Preventing Delayed Gastric Emptying After Whipple's Procedure—Isolated Roux Loop Reconstruction With Pancreaticogastrostomy

Pylorus preservation pancreatectomy or not

Pancreaticoduodenectomy for periampullary tumors at Dr. Cipto Mangunkusumo Hospital, Jakarta

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