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A new reconstruction method for preventing delayed gastric emptying after pylorus-preserving pancreatoduodenectomy

https://doi.org/10.1016/j.amjsurg.2003.10.013Get rights and content

Abstract

Background

With the aim of preventing delayed gastric emptying after pylorus-preserving pancreatoduodenectomy (PPPD), we devised a new reconstruction method in which the pancreas and the bile duct are anastomosed to the proximal jejunum brought through the transverse mesocolon, and the duodenum is antecolically anastomosed to the jejunum below the mesocolon. The right gastric artery is divided in order to place the stomach, the duodenum, and the jejunum in a straight line.

Methods

Thirty patients underwent PPPD with the new reconstruction method (n = 12) or the conventional method (all anastomoses performed retrocolically; n = 18). Early and late complications were compared between the two groups.

Results

Delayed gastric emptying occurred respectively in 1 patient (8%) and 13 patients (72%) operated on by the new and conventional method (P <0.001). The incidences of other complications did not differ significantly between the two groups.

Conclusions

The new reconstruction method may prevent delayed gastric emptying after PPPD.

Section snippets

Technique

In PPPD employing our new reconstruction method, the right gastroepiploic vessels are divided at their origin while the gastroepiploic arcade is preserved along the greater curvature. The right gastric artery is divided at its origin. This procedure allows the stomach and the proximal duodenum to be mobilized downward in a straight line. The duodenum is transected 1 to 5 cm distal to the pylorus. Peripyloric and hepatoduodenal lymph nodes are dissected, if necessary. The left gastric artery and

Results

Patient age and sex, histopathologic diagnosis, and preoperative factors (previous abdominal surgery and diabetes) associated with gastric emptying problems were comparable between the new and conventional reconstruction method groups (Table 1). Operation time and intraoperative blood loss did not differ significantly between the two groups. The right gastric artery was divided in all patients in the new method group and in 33% of patients in the conventional method group. The length of the

Comments

The pathogenesis of delayed gastric emptying after PPPD is not fully elucidated but there are several possibilities: (1) gastric dysrhythmias due to damage to the vagal nerve [8], [9] or certain intraabdominal complications such as anastomotic leak or abscess [10]; (2) gastric atony secondary to the disruption of gastroduodenal neural connections or resection of the duodenal pace setter [11]; (3) gastric atony in response to decreased plasma motilin level [12]; (4) ischemic injury to the

References (16)

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