Delayed gastric emptying after subtotal stomach-preserving pancreatoduodenectomy: pancreatogastrostomy vs pancreatojejunostomy

Objective
The relation between type of pancreatic remnant reconstruction and delayed gastric emptying (DGE) following pancreatoduodenectomy (PD) is unclear. The authors are trying to detect the incidence of DGE following PD and its relation to both types of pancreatic remnant anastomosis, pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ).
Patient and methods
This retrospective study included 44 patients who underwent PD. These patients were classified according to the type of pancreatic anastomosis into two groups: PG group and PJ group. The development of DGE and its combination with intra-abdominal complications (IACs) was compared between both groups. Risk factors responsible for clinically evident DGE were analyzed.
Results
The incidence of GDE in both PG and PJ was 27.3%. DGE was strongly associated with IACs, particularly pancreatic fistula. Furthermore, DGE occurred more commonly with PG than PJ. Although IACs developed at a similar rate in both types of pancreatic reconstruction, DGE in combination with IACs was more frequent with PG. Durations of both nasogastric tube and solid diet tolerance were prolonged in DGE patients in comparison with non-DGE patients. Moreover, prokinetic use, nasogastric tube reinsertion, and vomiting were more frequent in DGE patients than non-DGE patients.
Conclusion
DGE was strongly associated IACs. Regarding the type of pancreatic reconstruction, DGE is more common with PG than PJ. This may be because IACs developed more frequently with PG, resulting in more frequent development of DGE.