Objective: To find out which factors influence the development of delayed gastric emptying (DGE) after pancreaticoduodenectomy with pancreaticogastrostomy.
Design: Prospective clinical study.
Setting: University hospital, France.
Subjects: 88 patients of 103 consecutive patients who had had pancreaticoduodenectomies, November 1991-November 1997.
Interventions: Whipple resection, and parenteral and enteral nutrition.
Main outcome measures: Mortality, morbidity, and development of DGE (defined as the need for a postoperative nasogastric tube for 10 days or longer).
Results: One patient died, and 44 developed postoperative complications. 36 patients (41%) developed DGE in 21 of whom (58%, 24% of the total) it was in isolation, with no other complication; and 52 (59%) did not. There were significant differences between those who developed DGE and those who did not: 30 men (83%) compared with 6 women (17%) developed DGE compared with 32 (62%) and 20 (38%) (p = 0.03;); 15 (42%) developed a complication as well as DGE compared with 8 (15%) (p = 0.005); 10(28%) who developed DGE required reoperation compared with 4(8%) (p = 0.011); mean (SD) hospital stay was 30(12) days among those with DGE compared with 17 (5) days (p= 0.0001); and their mean (SD) serum protein concentration on day 1 was 46 (1) compared with 51 (7) g/L (p=0.01). Multivariate analysis showed that three factors independently influenced the development of DGE: sex (p = 0.01), the need for reoperation (p = 0.03) and the mean serum protein concentration on day 1 (p = 0.04).
Conclusion: Postoperative complication and the need for reoperation remain the most common factors linked to the development of DGE. However, in a quarter of patients DGE was not associated with any postoperative complication.