Is delayed gastric emptying following pancreaticoduodenectomy related to pylorus preservation?

Abstract

DGE after PPPD seems to be of minor clinical importance following uncomplicated surgery. When taking the results into consideration, it can be said that, despite the lack of a control group, antecolic duodenojejunostomy might be the key to a low incidence of DGE after PPPD. In our experience, DGE is linked to the occurrence of other postoperative complications rather than to pylorus preservation.

Delayed gastric emptying is associated with pylorus-preserving but not classical Whipple pancreaticoduodenectomy: A review of the literature and critical reappraisal of the implicated pathomechanism

“…Horstmann and associates [73] showed that the incidence of DGE increases from 1% when no postoperative complications occur, to 28% and 43% respectively when moderate (wound infection, temporary cardiopulmonary complications, transient occurrence of amylase/lipase-rich drainage fluid without signs of sepsis) and severe (anastomotic leakage, bleeding, septic complications, reoperation) complications occur (P < 0.0001). The results of several other studies lend support to this theory [16,27,33,[74][75][76][77] . An in-depth analysis of the physiolog y of the mechanism underlying the occurrence of DGE has also been reported, showing that the initiation of interdigestive phase Ⅲ is closely related to the elevation of plasma motilin concentration [78] .…”

Prevention of gastrostasis after pancreaticoduodenal resection: new technique of gastroenterostomy

“…According to randomized controlled investiga- [43], antecolic gastrojejunostomy decreases incidence of complications and gastrostasis (5% vs. 50%). Similar results were obtained earlier by I.Kurosaki and colleagues (8% vs. 74%), M.Sugiyama and colleagues (8% vs. 72%) [41], O.Horstmann and colleagues (12% vs. 25%) [10].…”

“…Type of gastroenterostomy effects on incidence of gastrostasis what was proved by several investigations [10,19,41]. According to randomized controlled investiga- [43], antecolic gastrojejunostomy decreases incidence of complications and gastrostasis (5% vs. 50%).…”

“…Влияние локализации гастроэнтероанастомоза по отношению к ободочной кишке на развитие га-стростаза доказано в нескольких исследованиях [10,19,41]. По данным рандомизированного контроли-руемого исследования [43], впередиободочный ва-риант обеспечивает меньшую частоту осложнений и гастростаза (5% против 50%).…”

Combined Antrectomy Reduces the Incidence of Delayed Gastric Emptying after Pancreatoduodenectomy

“…Other than these chemical or functional factors, suggested mechanical causes of DGE after PD include the interruption of the vagal nerve around the stomach with ischemia around the pylorus ring or forecourt part of the pylorus [20], distortion or twisting of the gastrojejunostomy [19,30], and left-sided portal hypertension or gastric congestion [31]. Ischemia of the stomach especially around the forecourt part of the pylorus is easily developed because the right gastric artery and right gastroepiploic artery are divided during a PD procedure.…”