Year 2019 / Volume 111 / Number 1
Original
Delayed gastric emptying following pancreatoduodenectomy: a Roux-en-Y gastrojejunostomy vs Billroth II gastrojejunostomy randomized study

34-39

DOI: 10.17235/reed.2018.5744/2018

Javier Herrera Cabezón, Pablo Sánchez Acedo, Antonio Tarifa Castilla, Cruz Zazpe Ripa,

Abstract
Introduction: delayed gastric emptying (DGE) is the most common complication after pancreaticoduodenectomy (PD) and it occurs in 50% of cases. Objectives: the endpoint was to determine if there were any differences in the incidence of DGE between Roux-en-Y gastrojejunostomy (ReY) and Billroth II gastrojejunostomy (BII) in PD with pancreaticogastrostomy (PG). Methods: this was a case-control prospective randomized study of all PD cases between 2013 and 2016. Sixty-four patients were included, 32 in each group. An intention-to-treat statistical analysis was performed. Results: no significant differences were found with regard to morbidity and mortality or hospital stay. DGE was present in 25% of the patients in the BII group in comparison to 15.6% in the ReY group, which was not statistically significant (p = 0.35). There was a higher percentage of patients with primary DGE in the BII group, 12.5% versus 6.2%, but this was not statistically significant (p = 0.53). No difference in DGE severity was observed. Male gender (OR 8.38 [1.1; 129]), abdominal complications (OR 15 [1.7; 396.9]), pre-operative malnutrition (OR 99.7 [3.3, 11,126]) and hemorrhage (OR 9.4 [1.37, 107.94]) were the main risk factors for DGE according to the multivariate analysis. Conclusions: there were no significant differences in the incidence or severity of DGE between BII or ReY after PD with PG.
Share Button
New comment
Comments
No comments for this article
References
1. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142(5):761-768. doi:10.1016/j.surg.2007.05.005.
2. Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142(1):20-25. doi:10.1016/j.surg.2007.02.001.
3. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8-13. doi:10.1016/j.surg.2005.05.001.
4. Gangavatiker R, Pal S, Javed A, et al. Effect of antecolic or retrocolic reconstruction of the gastro/duodenojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: a randomized controlled trial. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2011;15(5):843-852. doi:10.1007/s11605-011-1480-3.
5. Noorani A, Rangelova E, Del Chiaro M, et al. Delayed Gastric Emptying after Pancreatic Surgery: Analysis of Factors Determinant for the Short-term Outcome. Front Surg. 2016;3:25. doi:10.3389/fsurg.2016.00025.
6. Yang J, Wang C, Huang Q. Effect of Billroth II or Roux-en-Y Reconstruction for the Gastrojejunostomy After Pancreaticoduodenectomy: Meta-analysis of Randomized Controlled Trials. J Gastrointest Surg. 2015;19(5):955-963. doi:10.1007/s11605-015-2751-1.
7. Deng LH, Xiong JJ, Xia Q. Isolated Roux-en-Y pancreaticojejunostomy versus conventional pancreaticojejunostomy after pancreaticoduodenectomy: a systematic review and meta-analysis. J Evid Based Med. 2017;10(1):37-45. doi:10.1111/jebm.12202.
8. Herrera-Cabezón FJ, Sánchez-Acedo P, Zazpe-Ripa C, et al. Quality standards in 480 pancreatic resections: a prospective observational study. Rev Esp Enferm Dig. 2015;107(3):143-151. http://www.ncbi.nlm.nih.gov/pubmed/25733038. Accessed December 15, 2017.
9. Welsch T, Borm M, Degrate L, et al. Evaluation of the International Study Group of Pancreatic Surgery definition of delayed gastric emptying after pancreatoduodenectomy in a high-volume centre. Br J Surg. 2010;97(7):1043-1050. doi:10.1002/bjs.7071.
10. Tan WJ, Kow AWC, Liau KH. Moving towards the New International Study Group for Pancreatic Surgery (ISGPS) definitions in pancreaticoduodenectomy: a comparison between the old and new. HPB Off J Int Hepato Pancreato Biliary Assoc. 2011;13(8):566-572. doi:10.1111/j.1477-2574.2011.00336.x.
11. Pessaux P, Varma D, Arnaud J-P. Pancreaticoduodenectomy: superior mesenteric artery first approach. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2006;10(4):607-611. doi:10.1016/j.gassur.2005.05.001.
12. Marzano E, Piardi T, Pessaux P. The “hanging maneuver” technique during pancreaticoduodenectomy: The result of a technical evolution to approach the superior mesenteric artery. JOP J pancreas. 2011;12(4):429-430.
13. Shukla PJ, Barreto SG, Fingerhut A, et al. Toward improving uniformity and standardization in the reporting of pancreatic anastomoses: a new classification system by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2010;147(1):144-153. doi:10.1016/j.surg.2009.09.003.
14. Delcore R, Thomas JH, Pierce GE, et al. Pancreatogastrostomy: a safe drainage procedure after pancreatoduodenectomy. Surgery. 1990;108(4):641-645; discussion 645-647. http://www.ncbi.nlm.nih.gov/pubmed/2218874.
15. Tol JAMG, Gouma DJ, Bassi C, et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery. 2014;156(3):591-600. doi:10.1016/j.surg.2014.06.016.
16. Gockel I, Domeyer M, Wolloscheck T, et al. Resection of the mesopancreas (RMP): a new surgical classification of a known anatomical space. World J Surg Oncol. 2007;5:44. doi:10.1186/1477-7819-5-44.
17. Haljamäe H. Anesthetic risk factors. Acta Chir Scand Suppl. 1989;550:11-9; discussion 19-21. http://www.ncbi.nlm.nih.gov/pubmed/2652961. Accessed July 13, 2018.
18. Dindo D, Demartines N, Clavien P-A. Classification of Surgical Complications. Ann Surg. 2004;240(2):205-213. doi:10.1097/01.sla.0000133083.54934.ae.
19. Seltzer MH, Bastidas JA, Cooper DM, et al. Instant Nutritional Assessment. J Parenter Enter Nutr. 1979;3(3):157-159. doi:10.1177/014860717900300309.
20. Courvoisier T, Donatini G, Faure JP, et al. Primary versus secondary delayed gastric emptying (DGE) grades B and C of the International Study Group of Pancreatic Surgery after pancreatoduodenectomy: a retrospective analysis on a group of 132 patients. Updates Surg. 2015;67(3):305-309. doi:10.1007/s13304-015-0296-1.
21. Shimoda M, Kubota K, Katoh M, et al. Effect of billroth II or Roux-en-Y reconstruction for the gastrojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: a randomized controlled study. Ann Surg. 2013;257(5):938-942. doi:10.1097/SLA.0b013e31826c3f90.
22. Keck T, Wellner UF, Bahra M, et al. Pancreatogastrostomy Versus Pancreatojejunostomy for RECOnstruction After PANCreatoduodenectomy (RECOPANC, DRKS 00000767): Perioperative and Long-term Results of a Multicenter Randomized Controlled Trial. Ann Surg. 2016;263(3):440-449. doi:10.1097/SLA.0000000000001240.
23. Sakamoto Y, Yamamoto Y, Hata S, et al. Analysis of risk factors for delayed gastric emptying (DGE) after 387 pancreaticoduodenectomies with usage of 70 stapled reconstructions. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2011;15(10):1789-1797. doi:10.1007/s11605-011-1498-6.
24. Kunstman JW, Fonseca AL, Ciarleglio MM, et al. Comprehensive analysis of variables affecting delayed gastric emptying following pancreaticoduodenectomy. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2012;16(7):1354-1361. doi:10.1007/s11605-012-1873-y.
25. Healy JM, Kunstman JW, Salem RR. Proposal and Critical Appraisal of Exclusion Criteria to the International Study Group for Pancreatic Surgery Definition of Delayed Gastric Emptying. J Am Coll Surg. 2015;220(6):1036-1043.e1. doi:10.1016/j.jamcollsurg.2014.12.017.
26. Lassen K, Coolsen MME, Slim K, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr. 2012;31(6):817-830. doi:10.1016/j.clnu.2012.08.011.
27. Akizuki E, Kimura Y, Nobuoka 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(6):986-994. doi:10.1097/SLA.0b013e3181a63c4c.
Citation tools
Herrera Cabezón J, Sánchez Acedo P, Tarifa Castilla A, Zazpe Ripa C. Delayed gastric emptying following pancreatoduodenectomy: a Roux-en-Y gastrojejunostomy vs Billroth II gastrojejunostomy randomized study. 5744/2018


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1521 visits.
This article has been downloaded 339 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 24/05/2018

Accepted: 26/07/2018

Online First: 04/10/2018

Published: 17/01/2019

Article revision time: 53 days

Article Online First time: 133 days

Article editing time: 238 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology