Clinical and surgical factors influencing delayed gastric emptying after pyloric-preserving pancreaticoduodenectomy

Background/Aims: Delayed gastric emptying (DGE) is the most common and troublesome complication after pylorus-preserving pancreaticoduodenectomy (PPPD), however, definitive treatment has not yet been established. We examined the clinical and surgical factors relevant to DGE using multivariate analyses. Methodology: Forty-four patients with PPPD were divided into two groups according to reconstructive technique: group A (25), Billroth 11 type with antecolic duodenojejunostomy and group B (19), Billroth-I type. Multiple clinical and surgical factors influencing DGE were evaluated by univariate and multivariate analyses. Results: The period and output of gastric aspiration were significantly reduced in group A compared with group B (a median of 3 days us. 14 days and a mean output of 133+26mL vs. 506+80mL, respectively; P<0.0001). Re-insertion of the tube was required in 8% of group A compared with 32% of group B. A liquid or solid diet was started at medians of 8 and 14 days in group A compared with 22 and 28 days in group B (p<0.0001), respectively. Multivariate analyses disclosed that the antecolic duodenojejunostomy and major complication were two exclusive independent predictors of restoration of gastric motility. Conclusions: Occurrence of DGE was strongly affected by reconstruction technique and major complication. Billroth 11 reconstruction with antecolic duodenojejunostomy seems to be a useful technique to minimize the occurrence of DGE.