Abstract
Background: Delayed gastric emptying (DGE) is one of the most common reasons for morbidity after pancreatoduodenectomy. Technical characteristics of anastomosis which you affect may offer a relevant chance to improve postoperative DGE rates. We investigated the effect of a technical modification of gastrojejunostomy after the classical pancreaticoduodenectomy on DGE.
Materials and Methods: A total of 144 patients underwent classical pancreaticoduodenectomy (with 20-40 per cent antrectomy) due to pancreatic adenocarcinoma at the Department of General Surgery, Marmara University, School of Medicine Hospital, from February 2019 to May 2013, and those who met the inclusion criteria were enrolled. 107 patients had undergone classical end-to-side gastrojejunostomy (Classical GJ group), and 37 had undergone Marmara-Yegen cutting partially side-to-side gastrojejunostomy (M-Yc group). The postoperative DGE rates of both groups were compared according to the International Study Group of Pancreatic Surgery (ISGPS) definition of DGE. In addition, a multivariate analysis of the influencing factors for DGE development and severity has also been conducted.
Results: The total incidence of DGE was 36.4% in the Classical GJ group and 21.6% in the (M-Yc group). Although there was no significant difference between the groups regarding DGE and DGE grade rates (p=0.097), DGE was distinctly lower in the M-Yc GJ group than the Classical GJ group. In the multivariate analysis determined the presence of intra-abdominal fluids/collections, the use of the ERCP route for biliary drainage, and PTBD as independent predictors for DGE.
Conclusions: We tried to clarify the mechanism of DGE from the anatomic configuration aspect. The incidence and severity of DGE decreased in patients who underwent M-Yc GJ.