Surgical techniques to prevent delayed gastric emptying after pancreaticoduodenectomy

Peng Duan; Lu Sun; Kai Kou; Xin-Rui Li; Ping Zhang

doi:10.1016/j.hbpd.2023.11.001

Surgical techniques to prevent delayed gastric emptying after pancreaticoduodenectomy

Hepatobiliary Pancreat Dis Int. 2023 Nov 7:S1499-3872(23)00204-7. doi: 10.1016/j.hbpd.2023.11.001. Online ahead of print.

Authors

Peng Duan¹, Lu Sun¹, Kai Kou¹, Xin-Rui Li², Ping Zhang³

Affiliations

¹ Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun 130021, China.
² Department of Dental Implantology, Hospital of Stomatology, Jilin University, Changchun 130021, China.
³ Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun 130021, China. Electronic address: z_ping@jlu.edu.cn.

PMID: 37980179
DOI: 10.1016/j.hbpd.2023.11.001

Abstract

Background: Delayed gastric emptying (DGE) is one of the most common complications after pancreaticoduodenectomy (PD). DGE represents impaired gastric motility without significant mechanical obstruction and is associated with an increased length of hospital stay, increased healthcare costs, and a high readmission rate. We reviewed published studies on various technical modifications to reduce the incidence of DGE.

Data sources: Studies were identified by searching PubMed for relevant articles published up to December 2022. The following search terms were used: "pancreaticoduodenectomy", "pancreaticojejunostomy", "pancreaticogastrostomy", "gastric emptying", "gastroparesis" and "postoperative complications". The search was limited to English publications. Additional articles were identified by a manual search of references from key articles.

Results: In recent years, various surgical procedures and techniques have been explored to reduce the incidence of DGE. Pyloric resection, Billroth II reconstruction, Braun's enteroenterostomy, and antecolic reconstruction may be associated with a decreased incidence of DGE, but more high-powered studies are needed in the future. Neither laparoscopic nor robotic surgery has demonstrated superiority in preventing DGE, and the use of staplers is controversial regarding whether they can reduce the incidence of DGE.

Conclusions: Despite many innovations in surgical techniques, there is no surgical procedure that is superior to others to reduce DGE. Further larger prospective randomized studies are needed.

Keywords: Delayed gastric emptying; Pancreaticoduodenectomy; Postoperative complications; Surgical techniques.

Publication types

Review