Top

Published in:

01-06-2008 | original article

An Antecolic Roux-en Y type Reconstruction Decreased Delayed Gastric Emptying after Pylorus-Preserving Pancreatoduodenectomy

Authors: Yoshiaki Murakami, Kenichiro Uemura, Takeshi Sudo, Yasuo Hayashidani, Yasushi Hashimoto, Naoya Nakagawa, Hiroki Ohge, Taijiro Sueda

Published in: Journal of Gastrointestinal Surgery | Issue 6/2008

Abstract

The aim of this study was to identify a preferable procedure reducing the incidence of delayed gastric emptying (DGE) after pylorus-preserving pancreatoduodenectomy (PPPD). Data on 132 consecutive patients with pancreatobiliary disease, who underwent PPPD, were collected retrospectively. A retrocolic Billroth I type reconstruction (B-I group) and an antecolic Roux-en Y type reconstruction (R-Y group) were performed for 54 and 78 patients after PPPD, respectively. Clinical measures of DGE were compared between the two groups. The incidence of DGE was 81% in B-I group and 10% in R-Y group (P < 0.001). The type of reconstruction (P < 0.001), operative time (P = 0.016), and postoperative complications (P = 0.001) were significantly associated with DGE by univariate analysis. Only the type of reconstruction (P < 0.001) was identified as an independent factor, which was associated with DGE by multivariate analysis. An antecolic Roux-en Y type duodenojejunostomy could be a useful reconstruction method after PPPD to prevent the occurrence of DGE.

Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of Vater. Ann Surg 1935;102:763–779.PubMedCrossRef

Watson K. Carcinoma of the ampulla of Vater: successful radical resection. Br J Surg 1941;114:612–615.

Seiler CA, Wagner M, Bachmann T, Redaelli CA, Schmied B, Uhl W, Friess H, Buchler MW. Randomized clinical trial of pylorus-preserving duodenopancreatectomy versus classical Whipple resection-long term results. Br J Surg 2005;92:547–556.PubMedCrossRef

Tran KT, Smeenk HG, van Eijck CH, Kazemier G, Hop WC, Greve JW, Terpstra OT, Zijlstra JA, Klinkert P, Jeekel H. Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg 2004;240:738–745.PubMedCrossRef

Yeo CJ, Cameron JL, Lillemoe KD, Sohn TA, Campbell KA, Sauter PK, Coleman J, Abrams RA, Hruban RH. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 2002;236:355–368.PubMedCrossRef

Lin PW, Lin YJ. Prospective randomized comparison between pylorus-preserving and standard pancreaticoduodenectomy. Br J Surg 1999;86:603–607.PubMedCrossRef

Warshaw AL, Torchiana DL. Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy. Surg Gynecol Obstet 1985;160:1–4.PubMed

Patel AG, Toyama MT, Kusske AM, Alexander P, Ashley SW, Reber HA. Pylorus-preserving Whipple resection for pancreatic cancer. Is it any better? Arch Surg 1995;130:838–843.PubMed

Ohwada S, Ogawa T, Kawate S, Tanahashi Y, Iwazaki S, Tomizawa N, Yamada T, Ohya T, Morishita Y. Results of duct-to-mucosa pancreaticojejunostomy for pancreaticoduodenectomy Billroth I type reconstruction in 100 consecutive patients. J Am Coll Surg 2001;193:29–35.PubMedCrossRef

10.

Shan YS, Tsai ML, Chiu NT, Lin PW. Reconsideration of delayed gastric emptying in pancreaticoduodenectomy. World J Surg 2005;29:873–880.PubMedCrossRef

11.

Van Berge Henegouwen MI, van Gulik TM, DeWit LT, Allema JH, Rauws EA, Obertop H, Gouma DJ. Delayed gastric emptying after standard pancreaticoduodenectomy versus pylorus-preserving pancreaticoduodenectomy: an analysis of 200 consecutive patients. J Am Coll Surg 1997;185:373–379.PubMed

12.

Goei TH, Henegouwen MI, Slooff MJ, van Gulik TM, Gouma DJ, Eddes EH. Pylorus-preserving pancreatoduodenectomy: influence of a Billroth I versus a Billroth II type of reconstruction on gastric emptying. Dig Surg 2001;18:376–380.PubMedCrossRef

13.

Yeo CJ, Cameron JL, Maher MM, Sauter PK, Zahurak ML, Talamini MA, Lillemoe KD, Pitt HA. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg 1995;222:580–592.PubMedCrossRef

14.

Sugiyama M, Abe N, Ueki H, Masaki T, Mori T, Atomi Y. A new reconstruction method for preventing delayed gastric emptying after pylorus-preserving pancreatoduodenectomy. Am J Surg 2004;187:743–746.PubMedCrossRef

15.

Yeo CJ, Barry MK, Sauter PK, Sostre S, Lillemoe KD, Pitt HA, Cameron JL. Erythromycin accelerates gastric emptying after pancreaticoduodenectomy. A prospective, randomized, placebo-controlled trial. Ann Surg 1993;218:229–238.PubMedCrossRef

16.

Park YC, Kim SW, Jang JY, Ahn YJ, Park YH. Factors influencing delayed gastric emptying after pylorus-preserving pancreatoduodenectomy. J Am Coll Surg 2003;196:859–865.PubMedCrossRef

17.

Kurosaki I, Hatakeyama K. Preservation of the left gastric vein in delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy. J Gastrointest Surg 2005;9:846–852.PubMedCrossRef

18.

Tani M, Terasawa H, Kawai M, Ina S, Hirono S, Uchiyama K, Yamaue H. Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial. Ann Surg 2006;243:316–320.PubMedCrossRef

19.

Kim DK, Hindenburg AA, Sharma SK, Suk CH, Gress FG, Staszewski H, Grendell JH, Reed WP. Is pylorospasm a cause of delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy? Ann Surg Oncol 2005;12:222–227.PubMedCrossRef

20.

Murakami H, Yasue M. A vertical stomach reconstruction after pylorus-preserving pancreaticoduodenectomy. Am J Surg 2001;181:149–152.PubMedCrossRef

21.

Ohwada S, Satoh Y, Kawate S, Yamada T, Kawamura O, Koyama T, Yoshimura S, Tomizawa N, Ogawa T, Morishita Y. Low-dose erythromycin reduces delayed gastric emptying and improves gastric motility after Billroth I pylorus-preserving pancreaticoduodenectomy. Ann Surg 2001;234:668–674.PubMedCrossRef

22.

Takeda T, Yoshida J, Tanaka M, Matsunaga H, Yamaguchi K, Chijiiwa K. Delayed gastric emptying after Billroth I pylorus-preserving pancreatoduodenectomy: effect of postoperative time and cisapride. Ann Surg 1999;229:223–229.PubMedCrossRef

23.

Bassi C, Falconi M, Molinari E, Salvia R, Butturini G, Sartori N, Mantovani W, Pederzoli P. Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg 2005;242:767–771.PubMedCrossRef

24.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13.PubMedCrossRef

25.

McAfee MK, van Heerden JA, Adson MA. Is proximal pancreatoduodenectomy with pyloric preservation superior to total pancreatectomy? Surgery 1989;105:347–351.PubMed

26.

Warshaw AL, Torchiana DL. Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy. Surg Gynecol Obstet 1985;160:1–4.PubMed

27.

Kurosaki I, Hatakeyama K. Clinical and surgical factors influencing delayed gastric emptying after pyloric-preserving pancreaticoduodenectomy. Hepatogastroenterology 2005;52:143–148.PubMed

28.

Horstmann O, Becker H, Post S, Nustede R. Is delayed gastric emptying following pancreaticoduodenectomy related to pylorus preservation? Langenbecks Arch Surg. 1999;384:354–359.PubMedCrossRef

29.

Gauvin JM, Sarmiento JM, Sarr MG. Pylorus-preserving pancreaticoduodenectomy with complete preservation of the pyloroduodenal blood supply and innervation. Arch Surg 2003;138:1261–1263.PubMedCrossRef

30.

Riediger H, Makowiec F, Schareck WD, Hopt UT, Adam U. Delayed gastric emptying after pylorus-preserving pancreatoduodenectomy is strongly related to other postoperative complications. J Gastrointest Surg 2003;7:758–765.PubMedCrossRef

Title: An Antecolic Roux-en Y type Reconstruction Decreased Delayed Gastric Emptying after Pylorus-Preserving Pancreatoduodenectomy
Authors: Yoshiaki Murakami
Kenichiro Uemura
Takeshi Sudo
Yasuo Hayashidani
Yasushi Hashimoto
Naoya Nakagawa
Hiroki Ohge
Taijiro Sueda
Publication date: 01-06-2008
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 6/2008
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-008-0483-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

An Antecolic Roux-en Y type Reconstruction Decreased Delayed Gastric Emptying after Pylorus-Preserving Pancreatoduodenectomy

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2008

Malignant Melanoma of the Gallbladder: A Report of Two Cases and Review of the Literature

Usefulness of Absorbable Sutures in Preventing Surgical Site Infection in Hepatectomy

The Mirizzi Syndrome: Multidisciplinary Management Promotes Optimal Outcomes

Keyhole Deformity: A Case Series

A Comprehensive Appraisal of the Surgical Treatment of Diffuse Esophageal Spasm

Peripheral Cholangiocarcinoma with Endoluminal Tumor Thrombus in Main Bile Duct Mimicking a Klatskin Tumor