Proximal Roux-en-y Gastrojejunal Anastomosis with Pyloric Ring Resection Improves Gastric Emptying After Pancreaticoduodenectomy

Omar Barakat, Martha N Cagigas, Shima Bozorgui, Claire F Ozaki, R Patrick Wood, Omar Barakat, Martha N Cagigas, Shima Bozorgui, Claire F Ozaki, R Patrick Wood

Abstract

Background: Delayed gastric emptying (DGE) is a common complication of pancreaticoduodenectomy. We determined the efficiency of a new reconstruction technique, designed to preserve motilin-secreting cells and maximize the utility of their receptors, in reducing the incidence of DGE after pancreaticoduodenectomy.

Methods: From April 2005 to September 2014, 217 consecutive patients underwent pancreaticoduodenectomy at our institution. Nine patients who underwent total pancreatectomy were excluded. We compared outcomes between patients who underwent pancreaticoduodenectomy with resection of the pyloric ring followed by proximal Roux-en-y gastrojejunal anastomosis (group I, n = 90) and patients who underwent standard pancreaticoduodenectomy with the orthotopic reconstruction technique (group II, n = 118).

Results: Overall and clinically relevant rates of DGE were significantly lower in group I than in group II (10 and 2.2 % vs. 57 and 24 %, respectively; p < 0.05). Length of hospital stay as a result of DGE was shorter in group I than in group II. In univariate analysis, older age, comorbidities, ASA grade 4, operative time, preoperative diabetes, standard reconstruction technique, and postoperative complications were significant risk factors for DGE. In multivariate analysis, older age, standard technique, and postoperative complications were independent risk factors for DGE.

Conclusion: Our new reconstruction technique reduces the occurrence of DGE after pancreaticoduodenectomy.

Keywords: Delayed gastric emptying; Motilin; Pancreatic cancer; Whipple.

Figures

Fig. 1
Fig. 1
Schematic illustrations showing (a) standard pancreaticoduodenectomy (PD) with orthotopic reconstruction (group II patients) and (b) PD with the new reconstruction technique (group I patients), which utilizes the proximal 35 to 40 cm of the jejunum for the gastrojejunal anastomosis (GJA) and the distal loop for the pancreatojejunal (PJ) and hepatojejunal (HJ) anastomosis. Both anastomoses are placed in a retrocolic position

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