TY - JOUR
T1 - Delayed gastric emptying after pylorus preserving pancreaticoduodenectomy - Does gastrointestinal reconstruction technique matter?
AU - Hanna, Mena M.
AU - Tamariz, Leonardo
AU - Gadde, Rahul
AU - Allen, Casey
AU - Sleeman, Danny
AU - Livingstone, Alan
AU - Yakoub, Danny
N1 - Publisher Copyright:
© 2016 Elsevier Inc. All rights reserved.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Background The best gastrointestinal reconstruction route after pylorus preserving pancreaticoduodenectomy remains debatable. We aimed to evaluate the incidence of delayed gastric emptying (DGE) after antecolic (AC) and retrocolic (RC) duodenojejunostomy in these patients. Data Sources Studies comparing AC to RC reconstruction after pylorus preserving pancreaticoduodenectomy were identified from literature databases (PubMed, MEDLINE, EMBASE, SCOPUS, and Cochrane). The meta-analysis included 10 studies with a total of 1,067 patients, where 504 patients underwent AC and 563 patients underwent RC reconstruction. The incidence of DGE was significantly lower with AC reconstruction in both randomized controlled trials (risk ratio =.44, confidence interval =.24 to.77, P =.005) and retrospective studies (risk ratio.21, confidence interval.14 to.30, P <.001) with less output and days of nasogastric tube use. AC reconstruction was associated with a decreased length of stay. There was no difference in operative time, blood loss, pancreatic fistula, and abdominal abscess/collections. Conclusions AC reconstruction seems to be associated with less DGE, with no association with pancreatic fistula or abscess formation.
AB - Background The best gastrointestinal reconstruction route after pylorus preserving pancreaticoduodenectomy remains debatable. We aimed to evaluate the incidence of delayed gastric emptying (DGE) after antecolic (AC) and retrocolic (RC) duodenojejunostomy in these patients. Data Sources Studies comparing AC to RC reconstruction after pylorus preserving pancreaticoduodenectomy were identified from literature databases (PubMed, MEDLINE, EMBASE, SCOPUS, and Cochrane). The meta-analysis included 10 studies with a total of 1,067 patients, where 504 patients underwent AC and 563 patients underwent RC reconstruction. The incidence of DGE was significantly lower with AC reconstruction in both randomized controlled trials (risk ratio =.44, confidence interval =.24 to.77, P =.005) and retrospective studies (risk ratio.21, confidence interval.14 to.30, P <.001) with less output and days of nasogastric tube use. AC reconstruction was associated with a decreased length of stay. There was no difference in operative time, blood loss, pancreatic fistula, and abdominal abscess/collections. Conclusions AC reconstruction seems to be associated with less DGE, with no association with pancreatic fistula or abscess formation.
KW - Antecolic
KW - Delayed gastric emptying
KW - Duodenojejunostomy
KW - Gastrojejunostomy
KW - Pylorus preserving pancreaticoduodenectomy
KW - Retrocolic
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U2 - 10.1016/j.amjsurg.2015.10.015
DO - 10.1016/j.amjsurg.2015.10.015
M3 - Review article
C2 - 26792273
AN - SCOPUS:84953774840
SN - 0002-9610
VL - 211
SP - 810
EP - 819
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 4
ER -