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Reduction of the Incidence of Delayed Gastric Emptying in Side-to-Side Gastrojejunostomy in Subtotal Stomach-Preserving Pancreaticoduodenectomy

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

One of the most common morbidities of pancreaticoduodenectomies is delayed gastric emptying (DGE). The recent advent of subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) attempts to lessen this troublesome complication; however, the incidence of DGE still remains to be 4.5–20 %. This study aims to evaluate whether the incidence of DGE can be reduced by the side-to-side gastric greater curvature-to-jejunal anastomosis in comparison with the gastric stump-to-jejunal end-to-side anastomosis in SSPPD.

Methods

Between October 2007 and September 2012, a total of 160 consecutive patients who had undergone SSPPD were analyzed retrospectively. In the first period (October 2007–March 2010), gastrojejunostomy was performed with end-to-side anastomosis in 80 patients (SSPPD-ETS group). In the second period (April 2010–September 2012), gastrojejunostomy was performed with the greater curvature side-to-jejunal side anastomosis in 80 patients (SSPPD-STS group). The postoperative data were collected prospectively in a database and reviewed retrospectively.

Results

The incidence of DGE was 21.3 % in the SSPPD-ETS group and 2.5 % in the SSPPD-STS group (P = 0.0002). According to the classification of the International Study Group of Pancreatic Surgery (ISGPS), the incidence of DGE of grades A, B, and C were 5, 5, and 7 in the SSPPD-ETS group and 0, 2, and 0 in the SSPPD-STS group, respectively. The overall morbidity and postoperative hospital stay of the two groups were not significantly different.

Conclusions

The greater curvature side-to-side anastomosis of gastrojejunostomy is associated with a reduced incidence of DGE after SSPPD.

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Acknowledgments

The authors thank Drs. Kiyotaka Imamura, Yoshihide Nanno, Mayu Shimaguchi, and Minori Ishii for their support in this study. Also, we thank the health care information managers and medical clerks who have participated in this study in collecting the patient data and Dr. Christine Kwan for help in preparing the English manuscript.

Conflict of Interest

Toru Nakamura and the other co-authors have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Teine-Keijinkai Hospital, Teine-ku, Sapporo, Japan

    Toru Nakamura, Yoshiyasu Ambo, Naoya Okada, Minoru Takada, Toru Shimizu, On Suzuki, Fumitaka Nakamura, Nobuichi Kashimura & Akihiro Kishida

  2. Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Toru Nakamura, Takehiro Noji & Satoshi Hirano

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  1. Toru Nakamura
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  2. Yoshiyasu Ambo
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Correspondence to Toru Nakamura.

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Nakamura, T., Ambo, Y., Noji, T. et al. Reduction of the Incidence of Delayed Gastric Emptying in Side-to-Side Gastrojejunostomy in Subtotal Stomach-Preserving Pancreaticoduodenectomy. J Gastrointest Surg 19, 1425–1432 (2015). https://doi.org/10.1007/s11605-015-2870-8

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  • DOI: https://doi.org/10.1007/s11605-015-2870-8

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