Varianten der retrokolischen Rekonstruktion nach partieller Pankreatoduodenektomie und deren Einfluss auf die Magenentleerung – infra- oder suprakolisch

Hafke, Jessica; Beekum, Cornelius van; Manekeller, Steffen; Vilz, Tim O.; Kalff, Jörg C.; Glowka, Tim R.

doi:10.1055/a-0632-1977

Cited by 5 publications

(3 citation statements)

References 30 publications

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“…Duodenoenterostomy was performed by joining the duodenal remnant to the jejunum either in front (antecolic) or behind (retrocolic) the transverse colon. If the latter was chosen, transmesocolic reconstruction was carried out with the anastomosis either above (supracolic) or below (infracolic) the mesenterium of the transverse colon [ 14 ]. Only in case of direct infiltration of the antrum, classic Whipple procedure with double-loop reconstruction was carried out.…”

Section: Methodsmentioning

confidence: 99%

“…A wide range of causative mechanisms has been proposed for DGE including pylorospasm and preoperative cholangitis [ 8 , 10 ] and most studies on DGE focused on the extent of resection and on the technique of reconstruction but failed to show superior strategies. Neither pylorus resection and -preservation [ 11 ], single- or double loop reconstruction [ 12 ] nor ante- or retrocolic reconstruction [ 13 ] with either infra- or supracolic reconstruction [ 14 ] influences the frequency of DGE after PD.…”

Section: Introductionmentioning

confidence: 99%

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Active smokers show ameliorated delayed gastric emptying after pancreatoduodenectomy

et al. 2021

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Background Delayed gastric emptying (DGE) is the most common complication following pancreatoduodenectomy (PD). The data about active smoking in relation to gastric motility have been inconsistent and specifically the effect of smoking on gastric emptying after PD has not yet been investigated in detail. Methods 295 patients at our department underwent PD between January 2009 and December 2019. Patients were analyzed in relation to demographic factors, diagnosis, pre-existing conditions, intraoperative characteristics, hospital stay, mortality and postoperative complications with special emphasis on DGE. All complications were classified according to the definitions of the International Study Group on Pancreatic Surgery. Results 274 patients were included in the study and analyzed regarding their smoking habits (non or former smokers, n = 88, 32.1% vs. active smokers, n = 186, 68.6%). Excluded were patients for whom no information about their smoking habits was available (n = 3), patients who had had gastric resection before (n = 4) and patients with prolonged postoperative resumption to normal diet independently from DGE (long-term ventilation > 7 days, fasting due to pancreatic fistula) (n = 14). Smokers were younger than non-smokers (61 vs. 69 years, p ≤ 0.001) and mainly male (73% male vs. 27% female). Smoking patients showed significantly more pre-existing pulmonary conditions (19% vs. 8%, p = 0.002) and alcohol abuse (48% vs. 23%, p ≤ 0.001). We observe more blood loss in smokers (800 [500–1237.5] vs. 600 [400–1000], p = 0.039), however administration of erythrocyte concentrates did not differ between both groups (0 [0–2] vs. 0 [0–2], p = 0.501). 58 out of 88 smokers (66%) and 147 out of 186 of non-smokers (79%) showed malign tumors (p = 0.019). 35 out of 88 active smokers (40%) and 98 out of 188 non- or former smokers (53%) developed DGE after surgery (p = 0.046) and smokers tolerated solid food intake more quickly than non-smokers (postoperative day (POD7 vs. POD10, p = 0.004). Active smokers were less at risk to develop DGE (p = 0.051) whereas patients with pulmonary preexisting conditions were at higher risk for developing DGE (p = 0.011). Conclusions Our data show that DGE occurs less common in active smokers and they tolerate solid food intake more quickly than non-smokers. Further observation studies and randomized, controlled multicentre studies without the deleterious effect of smoking, for instance by administration of a nicotine patch, are needed to examine if this effect is due to nicotine administration.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Active smokers show ameliorated delayed gastric emptying after pancreatoduodenectomy

et al. 2021

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“…PD was carried out with pancreatogastrostomy (PG) by default and a single-loop retrocolic reconstruction, in case of pyloric preservation, as previously described [ 22 ]. If a classical whipple procedure with antral resection was performed, due to infiltration into the distal stomach, reconstruction was either performed as a single-loop-duodenoenterostomy (DE) or as a BII- or ReY-reconstruction, depending upon the preference of the surgeon.…”

Section: Methodsmentioning

confidence: 99%

Delayed Gastric Emptying Does Not Influence Cancer-Specific Survival after Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma

Pillny¹,

Teschke²,

Enderes³

et al. 2022

JCM

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Background: Delayed gastric emptying (DGE) remains the most frequent complication following pancreatoduodenectomy (PD). The present study investigates the influence of delayed gastric emptying on cancer-specific survival after PD. Methods: We included 267 patients who underwent PD between 2014 and 2021. They were analyzed regarding demographic factors, pre- and perioperative characteristics, surgical complications, and long-term survival. Results: Patients with a higher Charlson Comorbidity Index (CCI) or pre-existing pulmonary disease suffered significantly more from DGE. When experiencing PPH, a prolonged hospital stay, or major overall complications (Clavien-Dindo °III-V) were more common in the DGE group. Tumor size over 3 cm negatively affected survival. Conclusions: DGE has no influence on long-term survival in PDAC patients, although it prolongs hospital stay.

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Obesity Does Not Influence Delayed Gastric Emptying Following Pancreatoduodenectomy

Enderes

Pillny

Matthaei

et al. 2022

Biology

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Background: The data about obesity on postoperative outcome after pancreatoduodenectomy (PD) are inconsistent, specifically in relation to gastric motility and delayed gastric emptying (DGE). Methods: Two hundred and eleven patients were included in the study and patients were retrospectively analyzed in respect to pre-existing obesity (obese patients having a body mass index (BMI) ≥ 30 kg/m2 vs. non-obese patients having a BMI < 30 kg/m2, n = 34, 16% vs. n = 177, 84%) in relation to demographic factors, comorbidities, intraoperative characteristics, mortality and postoperative complications with special emphasis on DGE. Results: Obese patients were more likely to develop clinically relevant pancreatic fistula grade B/C (p = 0.008) and intraabdominal abscess formations (p = 0.017). However, clinically relevant DGE grade B/C did not differ (p = 0.231) and, specifically, first day of solid food intake (p = 0.195), duration of intraoperative administered nasogastric tube (NGT) (p = 0.708), rate of re-insertion of NGT (0.123), total length of NGT (p = 0.471) or the need for parenteral nutrition (p = 0.815) were equally distributed. Moreover, mortality (p = 1.000) did not differ between the two groups. Conclusions: Obese patients do not show a higher mortality rate and are not at higher risk to develop DGE. We thus show that in our study, PD is feasible in the obese patient in regard to postoperative outcome with special emphasis on DGE.

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Varianten der retrokolischen Rekonstruktion nach partieller Pankreatoduodenektomie und deren Einfluss auf die Magenentleerung – infra- oder suprakolisch

Abstract: Supra- or infracolic reconstruction does not influence the frequency of DGE following pancreatoduodenectomy. When DGE occurs, hospital stay is delayed. Somatostatin analogues may act prophylactically on DGE.

Cited by 5 publications

References 30 publications

Active smokers show ameliorated delayed gastric emptying after pancreatoduodenectomy

Active smokers show ameliorated delayed gastric emptying after pancreatoduodenectomy

Delayed Gastric Emptying Does Not Influence Cancer-Specific Survival after Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma

Obesity Does Not Influence Delayed Gastric Emptying Following Pancreatoduodenectomy

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