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Delayed Gastric Emptying After Pancreaticoduodenectomy: Is Subtotal Stomach Preserving Better or Pylorus Preserving?

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

An Erratum to this article was published on 01 July 2015

Abstract

Background

Delayed gastric emptying (DGE) is one of the main complications after pancreaticoduodenectomy (PD). Literature review and meta-analysis were used to evaluate whether subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) may have less incidence than pylorus-preserving pancreaticoduodenectomy (PPPD).

Methods

Online search for studies comparing PPPD to SSPPD was done. Primary outcome was DGE. Quality of included studies was evaluated and heterogeneity was assessed. Relative risk (RR) and 95 % confidence intervals (CI) were calculated from pooled data in RCTs and retrospective studies.

Results

Eight studies met our selection criteria, with a total of 663 patients undergoing pancreaticoduodenectomy; 309 underwent PPPD and 354 underwent SSPPD. Median age was 66 years. Average male/female ratio was 57 vs. 43 %, respectively. There was lower incidence of DGE with SSPPD (RR 0.527; 95 % CI 0.363–0.763; p < 0.001) and less nasogastric tube days with SSPPD (RR −0.544; 95 % CI −876 to −0.008; p = 0.047). Operative blood loss was more in SSPPD (RR 0.285; 95 % CI 0.071–0.499; p = 0.009). There was no statistical difference between the two groups regarding length of hospital stay, incidence of pancreatic fistula, abscesses, overall morbidity, or postoperative mortality.

Conclusion

SSPPD was associated with less DGE than PPPD. Larger prospective randomized studies are needed to investigate the association of this result with other complications in more depth.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA

    Mena Hanna, Rahul Gadde, Casey Allen, Jonathan Meizoso, Danny Sleeman, Alan Livingstone & Danny Yakoub

  2. Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA

    Rahul Gadde & Leonardo Tamariz

  3. Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA

    Danny Sleeman, Alan Livingstone & Danny Yakoub

  4. Division of Surgical Oncology, University of Miami Miller School of Medicine, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA

    Danny Yakoub

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  1. Mena Hanna
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Correspondence to Danny Yakoub.

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Hanna, M., Gadde, R., Tamariz, L. et al. Delayed Gastric Emptying After Pancreaticoduodenectomy: Is Subtotal Stomach Preserving Better or Pylorus Preserving?. J Gastrointest Surg 19, 1542–1552 (2015). https://doi.org/10.1007/s11605-015-2816-1

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  • DOI: https://doi.org/10.1007/s11605-015-2816-1

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