Nasogastric Drainage May Be Unnecessary after Pancreaticoduodenectomy: A Comparison of Routine vs Selective Decompression

Kunstman, John W.; Klemen, Nicholas D.; Fonseca, Annabelle L.; Araya, Deborah L.; Salem, Ronald R.

doi:10.1016/j.jamcollsurg.2013.04.031

Cited by 44 publications

(29 citation statements)

References 31 publications

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“…8,11,12,16 Furthermore, there has been a report that nasogastric drainage may be unnecessary after pylorus preserving pancreaticoduodenectomy. 17 Our data indicate that pylorus-preservation did not cause delayed gastric emptying. This might support postoperative management without nasogastric drainage.…”

Section: Discussionsupporting

confidence: 47%

Our Contrivances to Diminish Complications After Pylorus-Preserving Pancreaticoduodenectomy

Shimura

Suzuki

Araki

et al. 2015

International Surgery

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The objective of this study is to diminish postoperative complications after pylorus-preserving pancreaticoduodenectomy. Pylorus-preserving pancreaticoduodenectomy is still associated with major complications, especially leakage at pancreatojejunostomy and delayed gastric emptying. Traditional pylorus-preserving pancreaticoduodenectomy was performed in group A, while the novel procedure, an antecolic vertical duodenojejunostomy and internal pancreatic drainage with omental wrapping, was performed in group B (n = 40 each). We compared the following characteristics between the 2 groups: operation time, blood loss, time required before removal of nasogastric tube and resumption of food intake, length of hospital stay, and postoperative complications. The novel procedure required less time and was associated with less blood loss (both P < 0.0001). In the comparison of the 2 groups, group B showed less time for removal of nasogastric tubes and resumption of food intake, shorter hospital stays, and fewer postoperative complications (all P < 0.0001). The novel procedure appears to be a safe and effective alternative to traditional pancreaticoduodenectomy techniques.

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Section: Discussionsupporting

confidence: 47%

Our Contrivances to Diminish Complications After Pylorus-Preserving Pancreaticoduodenectomy

Shimura

Suzuki

Araki

et al. 2015

International Surgery

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“…The aetiology of DGE remains unclear. The point at issue is whether or not pylorus preservation, route of enteric reconstruction (antecolic versus retrocolic) or preoperative condition of patient affects DGE …”

Section: Discussionmentioning

confidence: 99%

Risk factors of delayed gastric emptying following pancreaticoduodenectomy

Liu¹,

Li²,

Xia

et al. 2014

ANZ Journal of Surgery

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Background: This study aims to explore the morbidity and risk factors of delayed gastric emptying (DGE) following pancreaticoduodenectomy. Methods: Between 1 January 2013 and 31 December 2013, data from 196 consecutive patients who underwent pancreaticoduodenectomy in the Chinese PLA General Hospital were recorded retrospectively. A total of 17 factors were examined with univariate analysis, and multivariate logistic regression analysis was used to estimate relative risks. Results: DGE occurred in 71 patients (36.2%). The incidence rates of grade A, grade B and grade C DGE were 22.4% (44/196), 6.1% (12/196) and 7.7% (15/196), respectively. There were three post-operative deaths for the entire series, with an overall mortality rate of 1.5%. Braun enteroenterostomy, clinically relevant post-operative pancreatic fistula (CR-POPF) and intra-abdominal collection correlated with DGE rates significantly in univariate analysis, whereas CR-POPF and intra-abdominal collection were independent risk factors in multivariate logistic regression analysis. Body mass index ≥25 kg/m

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“…After discarding duplicates an unrelated study according to the exclusion criteria, seven full-text articles were reviewed to assess further eligibility. In addition, one study was excluded because some patients in the NGD group underwent nasogastric tube insertion (NGT) [20]. Finally, six studies were included in the systematic review and meta-analysis [5,15,16,[21][22][23].…”

Section: Resultsmentioning

confidence: 99%

“…Third, because NG tube has been used following gastrointestinal anastomoses for several decades, it is difficult to change the clinical habit and radically stop using routine gastric decompression [32,33]. Instead of absolutely prohibiting RGD after pancreatic surgery, some surgeons preferred a more conservative method, namely selective NGT usage, such as when they unable to extubate the patient postoperatively [20]. In their retrospective study with 250 patients, Kunstman et al found that patients in the selective use of RGD had decreased incidence of delayed gastric emptying, length of stay, and time to dietary tolerance [20].…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Efficacy of gastric decompression after pancreatic surgery: a systematic review and meta-analysis

et al. 2020

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Background: Gastric decompression after pancreatic surgery has been a routine procedure for many years. However, this procedure has often been waived in non-pancreatic abdominal surgeries. The aim of this metaanalysis was to determine the necessity of routine gastric decompression (RGD) following pancreatic surgery. Methods: PubMed, the Cochrane Library, EMBASE, and Web of Science were systematically searched to identify relevant studies comparing outcomes of RGD and no gastric decompression (NGD) after pancreatic surgery. The overall complications, major complications, mortality, delayed gastric emptying (DGE); clinically relevant DGE (CR-DGE), postoperative pancreatic fistula (POPF), clinically relevant POPF (CR-POPF), secondary gastric decompression, and the length of hospital stay were evaluated. Results: A total of six comparative studies with a total of 940 patients were included. There were no differences between RGD and NGD groups in terms of the overall complications (OR = 1.73, 95% CI: 0.60-5.00; p = 0.31), major complications (OR = 2.22, 95% CI: 1.00-4.91; p = 0.05), incidence of secondary gastric decompression (OR = 1.19, 95% CI: 0.60-2.02; p = 0.61), incidence of overall DGE (OR = 2.74; 95% CI: 0.88-8.56; p = 0.08; I 2 = 88%), incidence of CR-POPF (OR = 1.28, 95% CI: 0.76-2.15; p = 0.36), and incidence of POPF (OR = 1.31, 95% CI: 0.81-2.14; p = 0.27). However, RGD was associated with a higher incidence of CR-DGE (OR = 5.45; 95% CI: 2.68-11.09; p < 0.001, I 2 = 35%), a higher rate of mortality (OR = 1.53; 95% CI: 1.05-2.24; p = 0.03; I 2 = 83%), and a longer length of hospital stay (WMD = 5.43, 95% CI: 0.30 to 10.56; p = 0.04; I 2 = 93%). Conclusions: Routine gastric decompression in patients after pancreatic surgery was not associated with a better recovery, and may be unnecessary after pancreatic surgery.

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Nasogastric Drainage May Be Unnecessary after Pancreaticoduodenectomy: A Comparison of Routine vs Selective Decompression

Cited by 44 publications

References 31 publications

Our Contrivances to Diminish Complications After Pylorus-Preserving Pancreaticoduodenectomy

Our Contrivances to Diminish Complications After Pylorus-Preserving Pancreaticoduodenectomy

Risk factors of delayed gastric emptying following pancreaticoduodenectomy

Efficacy of gastric decompression after pancreatic surgery: a systematic review and meta-analysis

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