Therapeutic strategies for the management of delayed gastric emptying after pancreatic resection

Abstract

The incidence of DGE in high-volume centers specialized in pancreatic surgery is well below 20%, thus following the improved rates that have been reported in the last decade regarding mortality and length of hospital stay after pancreatic surgery. DGE mandates a uniform definition and method of evaluation to achieve homogeneity among studies. Standardization of the operative technique, as well as "centralizing" pancreatic resections in high-volume centers, should aid to improve the occurrence of this bothersome postoperative complication.

LOW MORTALITY RATE IN 97 CONSECUTIVE PANCREATICODUODENECTOMIES: the experience of a group

“…It is our opinion that many of the labeled post-PDT gastroparesis are due to some technical fault in the manufacture of gastroenterostomy, such as angled anastomoses and/or with small diameter. Although it has been reported that pylorus-preserving PDT (PPPDT) and classical Whipple's PDT are equal operations regarding postoperative development of prolonged gastric stasis (10,19) , we believe that devascularization and denervation of the pylorus with subsequent pylorospasm in PPPDT may contribute to delayed gastric emptying.…”

“…Postgastrectomy syndrome that occurs after PDT, characterized by nausea, vomiting, diarrhea and dyspepsia, is a common complication in the postoperative period, with series reporting its incidence in up to 60% (16,19,39) . The pathophysiology is still poorly understood, but mechanical obstruction and reversible causes (abnormalities in serum electrolytes, poor glycemic control, use of narcotics and pain, among others) should be investigated and corrected before confirming this hypothesis.…”

“…The pathophysiology is still poorly understood, but mechanical obstruction and reversible causes (abnormalities in serum electrolytes, poor glycemic control, use of narcotics and pain, among others) should be investigated and corrected before confirming this hypothesis. It is postulated that the removal of the duodenum would be responsible for the decrease in serum motilin (19) , responsible for stimulating the migratory motor complex of the gastrointestinal tract. This hypothesis is supported by the positive results after the use of a motilin agonist in low doses, the macrolide antibiotic erythromycin (19,22) , which has been reported as a reduction factor of up to 37% in the incidence of gastroparesis.…”

“…It is postulated that the removal of the duodenum would be responsible for the decrease in serum motilin (19) , responsible for stimulating the migratory motor complex of the gastrointestinal tract. This hypothesis is supported by the positive results after the use of a motilin agonist in low doses, the macrolide antibiotic erythromycin (19,22) , which has been reported as a reduction factor of up to 37% in the incidence of gastroparesis. However, in daily practice, the symptoms caused by delayed gastric emptying can be improved by the use of prokinetic drugs, such as bromopride or metoclopramide.…”

“…Independent risk factors for the occurrence of prolonged gastric stasis are intra-abdominal complications such as pancreatic fistula and abscess, whose incidence grows proportionally to the severity of these complications (19) . Finally, the prolonged gastric stasis is not usually a serious complication with mortality risk, but can cause discomfort, increase the length of hospital stay, hospital costs, and reduce the quality of life postoperatively.…”