Delayed gastric emptying after pylorus preserving pancreaticoduodenectomy-does gastrointestinal reconstruction technique matter?

American Journal of Surgery
Mena M HannaDanny Yakoub

Abstract

The best gastrointestinal reconstruction route after pylorus preserving pancreaticoduodenectomy remains debatable. We aimed to evaluate the incidence of delayed gastric emptying (DGE) after antecolic (AC) and retrocolic (RC) duodenojejunostomy in these patients. Studies comparing AC to RC reconstruction after pylorus preserving pancreaticoduodenectomy were identified from literature databases (PubMed, MEDLINE, EMBASE, SCOPUS, and Cochrane). The meta-analysis included 10 studies with a total of 1,067 patients, where 504 patients underwent AC and 563 patients underwent RC reconstruction. The incidence of DGE was significantly lower with AC reconstruction in both randomized controlled trials (risk ratio = .44, confidence interval = .24 to.77, P = .005) and retrospective studies (risk ratio .21, confidence interval .14 to .30, P < .001) with less output and days of nasogastric tube use. AC reconstruction was associated with a decreased length of stay. There was no difference in operative time, blood loss, pancreatic fistula, and abdominal abscess/collections. AC reconstruction seems to be associated with less DGE, with no association with pancreatic fistula or abscess formation.

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Citations

May 27, 2017·Journal of Hepato-biliary-pancreatic Sciences·Yasuro FutagawaKatsuhiko Yanaga
Jan 10, 2018·Digestive Surgery·Shinjiro KobayashiTakehito Otsubo
Sep 19, 2019·Journal of Hepato-biliary-pancreatic Sciences·Chih-Yuan WangRong Liu
Jun 27, 2018·Langenbeck's Archives of Surgery·Elodie GaignardLaurent Sulpice
Jan 28, 2020·The Journal of Surgical Research·Philip C MüllerKaspar Z'graggen
Mar 28, 2021·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·K F FlickC M Schmidt
May 20, 2021·Risk Management and Healthcare Policy·Jia-Yu ZhangZhi-Ying Yang

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