Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지
DOI QR코드

DOI QR Code

Impact of route of reconstruction of gastrojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: A prospective randomized study

  • Lokesh Arora (Department of Surgical Gastroenterology, Sri Venkateswara Institute of Medical Sciences (SVIMS)) ;
  • Vutukuru Venkatarami Reddy (Department of Surgical Gastroenterology, Sri Venkateswara Institute of Medical Sciences (SVIMS)) ;
  • Sivarama Krishna Gavini (Department of Surgical Gastroenterology, Sri Venkateswara Institute of Medical Sciences (SVIMS)) ;
  • Chandramaliteeswaran Chandrakasan (Department of Surgical Gastroenterology, Sri Venkateswara Institute of Medical Sciences (SVIMS))
  • Received : 2022.12.02
  • Accepted : 2023.01.31
  • Published : 2023.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

Backgrounds/Aims: Pancreaticoduodenectomy (PD) is commonly performed pancreatic procedure for tumors of periampullary region. Delayed gastric emptying (DGE) and pancreatic fistula are the most common specific complications following PD. DGE can lead to significant morbidity, resulting in prolonged hospital stay and increased cost. Various factors might influence the occurrence of DGE. We hypothesized that kinking of jejunal limb could be a cause of DGE post PD. Methods: Antecolic (AC) and retrocolic (RC) side-to-side gastrojejunostomy (GJ) groups in classical PD were compared for the occurrence of DGE in a prospective study. All patients who underwent PD between April 2019 and September 2020 in a tertiary care center in south India were included in this study. Results: After classic PD, RC GJ was found to be superior to AC in terms of DGE rate (26.7% vs. 71.9%) and hospital stay (9 days vs. 11 days). Conclusions: Route of reconstruction of GJ can influence the occurrence of DGE as RC anastomosis in classical PD provides the most straight route for gastric emptying.

Keywords

References

  1. Akizuki E, Kimura Y, Nobuoka T, Imamura M, Nagayama M, Sonoda T, et al. Reconsideration of postoperative oral intake tolerance after pancreaticoduodenectomy: prospective consecutive analysis of delayed gastric emptying according to the ISGPS definition and the amount of dietary intake. Ann Surg 2009;249:986-994.  https://doi.org/10.1097/SLA.0b013e3181a63c4c
  2. Parmar AD, Sheffield KM, Vargas GM, Pitt HA, Kilbane EM, Hall BL, et al. Factors associated with delayed gastric emptying after pancreaticoduodenectomy. HPB (Oxford) 2013;15:763-772.  https://doi.org/10.1111/hpb.12129
  3. Murakami Y, Uemura K, Sudo T, Hayashidani Y, Hashimoto Y, Nakagawa N, et al. An antecolic Roux-en Y type reconstruction decreased delayed gastric emptying after pylorus-preserving pancreatoduodenectomy. J Gastrointest Surg 2008;12:1081-1086.  https://doi.org/10.1007/s11605-008-0483-1
  4. Hartel M, Wente MN, Hinz U, Kleeff J, Wagner M, Muller MW, et al. Effect of antecolic reconstruction on delayed gastric emptying after the pylorus-preserving Whipple procedure. Arch Surg 2005;140:1094-1099.  https://doi.org/10.1001/archsurg.140.11.1094
  5. Tani M, Terasawa H, Kawai M, Ina S, Hirono S, Uchiyama K, et al. Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial. Ann Surg 2006;243:316-320.  https://doi.org/10.1097/01.sla.0000201479.84934.ca
  6. Chijiiwa K, Imamura N, Ohuchida J, Hiyoshi M, Nagano M, Otani K, et al. Prospective randomized controlled study of gastric emptying assessed by (13)C-acetate breath test after pylorus-preserving pancreaticoduodenectomy: comparison between antecolic and vertical retrocolic duodenojejunostomy. J Hepatobiliary Pancreat Surg 2009;16:49-55.  https://doi.org/10.1007/s00534-008-0004-3
  7. Gangavatiker R, Pal S, Javed A, Dash NR, Sahni P, Chattopadhyay TK. Effect of antecolic or retrocolic reconstruction of the gastro/duodenojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: a randomized controlled trial. J Gastrointest Surg 2011;15:843-852.  https://doi.org/10.1007/s11605-011-1480-3
  8. Tamandl D, Sahora K, Prucker J, Schmid R, Holst JJ, Miholic J, et al. Impact of the reconstruction method on delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: a prospective randomized study. World J Surg 2014;38:465-475.  https://doi.org/10.1007/s00268-013-2274-4
  9. Kurahara H, Shinchi H, Maemura K, Mataki Y, Iino S, Sakoda M, et al. Delayed gastric emptying after pancreatoduodenectomy. J Surg Res 2011;171:e187-e192.  https://doi.org/10.1016/j.jss.2011.08.002
  10. Oida T, Mimatsu K, Kano H, Kawasaki A, Fukino N, Kida K, et al. Antecolic and retrocolic route on delayed gastric emptying after MSSPPD. Hepatogastroenterology 2012;59:1274-1276. 
  11. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007;142:761-768.  https://doi.org/10.1016/j.surg.2007.05.005
  12. van Berge Henegouwen MI, van Gulik TM, DeWit LT, Allema JH, Rauws EA, Obertop H, et al. Delayed gastric emptying after standard pancreaticoduodenectomy versus pylorus-preserving pancreaticoduodenectomy: an analysis of 200 consecutive patients. J Am Coll Surg 1997;185:373-379.  https://doi.org/10.1016/S1072-7515(01)00944-9
  13. Wellner UF, Sick O, Olschewski M, Adam U, Hopt UT, Keck T. Randomized controlled single-center trial comparing pancreatogastrostomy versus pancreaticojejunostomy after partial pancreatoduodenectomy. J Gastrointest Surg 2012;16:1686-1695.  https://doi.org/10.1007/s11605-012-1940-4
  14. Muller MW, Friess H, Beger HG, Kleeff J, Lauterburg B, Glasbrenner B, et al. Gastric emptying following pylorus-preserving Whipple and duodenum-preserving pancreatic head resection in patients with chronic pancreatitis. Am J Surg 1997;173:257-263.  https://doi.org/10.1016/S0002-9610(96)00402-3
  15. Masui T, Kubora T, Nakanishi Y, Aoki K, Sugimoto S, Takamura M, et al. The flow angle beneath the gastrojejunostomy predicts delayed gastric emptying in Roux-en-Y reconstruction after distal gastrectomy. Gastric Cancer 2012;15:281-286.  https://doi.org/10.1007/s10120-011-0107-4
  16. Sahora K, Morales-Oyarvide V, Thayer SP, Ferrone CR, Warshaw AL, Lillemoe KD, et al. The effect of antecolic versus retrocolic reconstruction on delayed gastric emptying after classic non-pylorus-preserving pancreaticoduodenectomy. Am J Surg 2015;209:1028-1035.  https://doi.org/10.1016/j.amjsurg.2014.04.015
  17. Hu HL, Zhou XD, Zhang Q, Shi X. Factors influencing delayed gastric emptying after pancreaticoduodenectomy - a meta-analysis. Hepatogastroenterology 2014;61:1539-1545. 
  18. Bell R, Pandanaboyana S, Shah N, Bartlett A, Windsor JA, Smith AM. Meta-analysis of antecolic versus retrocolic gastric reconstruction after a pylorus-preserving pancreatoduodenectomy. HPB (Oxford) 2015;17:202-208.  https://doi.org/10.1111/hpb.12344
  19. Imamura N, Chijiiwa K, Ohuchida J, Hiyoshi M, Nagano M, Otani K, et al. Prospective randomized clinical trial of a change in gastric emptying and nutritional status after a pylorus-preserving pancreaticoduodenectomy: comparison between an antecolic and a vertical retrocolic duodenojejunostomy. HPB (Oxford) 2014;16:384-394.  https://doi.org/10.1111/hpb.12153
  20. Zhou Y, Lin J, Wu L, Li B, Li H. Effect of antecolic or retrocolic reconstruction of the gastro/duodenojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: a meta-analysis. BMC Gastroenterol 2015;15:68. 
  21. Hanna MM, Tamariz L, Gadde R, Allen C, Sleeman D, Livingstone A, et al. Delayed gastric emptying after pylorus preserving pancreaticoduodenectomy-does gastrointestinal reconstruction technique matter? Am J Surg 2016;211:810-819.  https://doi.org/10.1016/j.amjsurg.2015.10.015
  22. Joliat GR, Labgaa I, Demartines N, Schafer M, Allemann P. Effect of antecolic versus retrocolic gastroenteric reconstruction after pancreaticoduodenectomy on delayed gastric emptying: a meta-analysis of six randomized controlled trials. Dig Surg 2016;33:15-25.  https://doi.org/10.1159/000441480
  23. Melloul E, Lassen K, Roulin D, Grass F, Perinel J, Adham M, et al. Guidelines for perioperative care for pancreatoduodenectomy: enhanced recovery after surgery (ERAS) recommendations 2019. World J Surg 2020;44:2056-2084.  https://doi.org/10.1007/s00268-020-05462-w
  24. Cao Y, Gu HY, Huang ZD, Wu YP, Zhang Q, Luo J, et al. Impact of enhanced recovery after surgery on postoperative recovery for pancreaticoduodenectomy: pooled analysis of observational study. Front Oncol 2019;9:687.