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

Mena M. Hanna, Leonardo Tamariz, Rahul Gadde, Casey Allen, Danny Sleeman, Alan Livingstone, Danny Yakoub

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: 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. Data Sources: 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. Conclusions: AC reconstruction seems to be associated with less DGE, with no association with pancreatic fistula or abscess formation.

Original languageEnglish (US)
JournalAmerican Journal of Surgery
DOIs
StateAccepted/In press - Mar 31 2015

Fingerprint

Pancreaticoduodenectomy
Gastric Emptying
Pylorus
Pancreatic Fistula
Odds Ratio
Confidence Intervals
Abdominal Abscess
Information Storage and Retrieval
Incidence
Operative Time
PubMed
MEDLINE
Abscess
Meta-Analysis
Length of Stay
Randomized Controlled Trials
Retrospective Studies
Databases

Keywords

  • Antecolic
  • Delayed gastric emptying
  • Duodenojejunostomy
  • Gastrojejunostomy
  • Pylorus preserving pancreaticoduodenectomy
  • Retrocolic

ASJC Scopus subject areas

  • Surgery

Cite this

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title = "Delayed gastric emptying after pylorus preserving pancreaticoduodenectomy-does gastrointestinal reconstruction technique matter?",
abstract = "Background: 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. Data Sources: 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. Conclusions: AC reconstruction seems to be associated with less DGE, with no association with pancreatic fistula or abscess formation.",
keywords = "Antecolic, Delayed gastric emptying, Duodenojejunostomy, Gastrojejunostomy, Pylorus preserving pancreaticoduodenectomy, Retrocolic",
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AU - Hanna, Mena M.

AU - Tamariz, Leonardo

AU - Gadde, Rahul

AU - Allen, Casey

AU - Sleeman, Danny

AU - Livingstone, Alan

AU - Yakoub, Danny

PY - 2015/3/31

Y1 - 2015/3/31

N2 - Background: 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. Data Sources: 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. Conclusions: AC reconstruction seems to be associated with less DGE, with no association with pancreatic fistula or abscess formation.

AB - Background: 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. Data Sources: 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. Conclusions: AC reconstruction seems to be associated with less DGE, with no association with pancreatic fistula or abscess formation.

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