Delayed gastric emptying after partial duodenopancreatectomy
Authors:
J. Leffler; T. Krejčí; B. East
Authors place of work:
Chirurgická klinika 2. LF a FN Motol, Praha, přednosta: Prof. MUDr. J. Hoch, CSc.
Published in the journal:
Rozhl. Chir., 2012, roč. 91, č. 8, s. 422-426.
Category:
Original articles
Práce byla věnována prof. MUDr. Jiřímu Hochovi, CSc. při příležitosti jeho významného životního jubilea.
Summary
Introduction:
Delayed gastric emptying (DGE) is a relatively common complication in patients after partial duodenopancreatectomy (PDPE) and significantly contributes to their postoperative morbidity. There has only been a small amount of interest attributed to DGE in Czech literature. The aim of this article is to present and analyze our own experience with the occurrence of DGE after PDPE.
Materials and methods:
Retrospective analysis of prospectively collected data from 106 patients who underwent a PDPE at the Department of Surgery, University Hospital Motol and 2nd Medical Faculty, between 2001 and 2011. The data were statistically analyzed using the Chi-square test with statistical significance set at 5% of probability value (p < 0.05).
Results:
During the reporting period, PDPE was performed in 106 patients with a pathological process in the pancreatic head. 4 patients died in the postoperative period (30-day mortality 3.8%). Major postoperative complications occurred in 31 patients (morbidity 29%), with clinically significant DGE (grade B and C) in almost half of them (16 patients). Along with the DGE, 4 patients suffered from other major complications (2 pancreatic anastomotic insufficiency, 1 bile fistula and 1 external pancreatic fistula). We did not prove a statistically significant difference in the incidence of DGE depending either on the type of resection or pancreatic anastomosis type.
Conclusion:
DGE contributes significantly to postoperative morbidity in patients after PDPE and is associated with other serious postoperative complications in a considerable number of cases.
Key words:
postoperative complications after PDPE – delayed gastric emptying – type of pancreatic anastomosis – treatment options
Zdroje
1. Vin Y, Sima CS, Getrajdman GI et al. Management and outcomes of postpancreatectomy fistula, leak and abscess: results of 908 pacients resected at single institution between 2000 and 2005. J Am Coll Surg 2008;207:490–498.
2. Yeo CJ, Cameron JL, Sohn TA et al. Six hundret fifty consecutive pancreaticoduodenectomies in the 1990s: patology, complications, and outcomes. Ann Surg 1997;226:248–257.
3. Balcom JH 4th, Rattner DW, Warshaw AL et al. Ten-year experience with 733 pancreatic resections: changing indications, older patiens, and decreasing lenght od hospitalisation. Arch Surg 2001;136:391–398.
4. Crist D, Sitzmann JV, Cameron JL. Improved hospitál morbidity, mortality and surfoval after the Whipple procedure. Ann Surg 1987;206:358–365.
5. Wente MN, Bassi C, Dervenis C, et al. Delayed Bystric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS), Surgery 2007;142:761–768.
6. Malleo G, Crippa S, Butturini G et al. Delayed Bystric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors. HPB 2010;12(9):610–618.
7. Lytras D, Paraskevas KI, Avgerinos C et al. Therapeutic strategie for the management of delayed gastric empying after pancreatic resection. Langenbecks Arch Surg 2007;392(1):1–12.
8. Eshuis WJ, van Dalen JW, Busch OR, et al. Route of gastroenteric reconstruction in pancreatoduodenectomy and delayed gastric emptying. HPB 2012;14(1):54–59.
9. Tani M, Terasawa H, Kawai M et al. Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy. Ann Surg 2006243(3):316–320.
10. Van Berge Henegouwen MI., van Gulik TM, DeWit LT et al. Delayed gastric emptying after standars pancreaticoduodenectomy versus pylorus- preserving pancreaticoduodenectomy: an analysis of 200 consecutive patiens. J Am Coll Surg 1997; 185:373–379.
11. Fabre JM, Burgel JS, Navarro F et al. Delayed gastric emptying after pancreaticoduodenectomy and pancreaticogastrostomy. Eur J Surg 1999;165:560–565.
12. Braasch JW, Deziel DJ, Rossi RL et al. Pyloric and gastric preserving pancreatic resection: experience with 87 patients. Ann Surg 1986;204:411–418.
13. Liberski SM, Kochal, Antip RG et al. Ischemic gastroparesis: resolution after revascularisation. Gastroenetology 1990;99:252–257.
14. Hartel M, Wente MN, Hinz U et al. Effect of antecolic reconstruction on delayed gastric emptying after the pylorus-preserving Whipple procedure. Arch Surg 2005;140:1094–1099.
15. Horstmann O, Markus PM, Ghadimi MB et al. Pylorus preservation has no impact on delayed gastric emptying after pancreatic head resection. Pankreas 2004;28:69–74.
16. Kingsnorth AN, Berg JD, Gray MR. A novel reconstructive technique for pylorus-preserving pancreaticoduodenectomy: avoidance of early postoperative gastric stasis. Ann R Coll Surg Engl 1993;75:38–42.
17. Paraskevas KI, Avgerinos C, Manes C et al. Delayed gastric emptying is associated with pylorus-preserving but not classical Whipple pancreaticoduodenectomy: A review of the literature and critical reappriasal of the implicated pathomechanism. World J Gastroenterol 2006;7,12(37):5951–5958.
18. Patel AG, Toyama MT, Kusske AM et al. Pylorus-preserving Whipple resection for pancreatic cancer. Is it any better? Arch Surg 1995;130:838–842.
19. Tran KT, Smeenk HG, van Eijck CH et al. Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg 2004;240:738–745.
20. Bassi C, Falconi M, Salvia R et al. Management of complications after pancreaticoduodenectomy in a high volume centre: results on 150 consecutive patiens. Dig Surg 2001;18:453–457.
21. Uravič M, Zelič M, Petrošič N et al. Effect of pyloric dilatation on gastric emptying after pylorus-preserving pancreaticoduodenectomy. Hepatogastroenterology 2011;5(112):2144–2147.
22. Bassi C, Falconi M, Molinari E et al. Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy. Ann Surg 2005;242(6):767–773.
23. Liddle RA, Merita ET, Conrad CK et al. Regulation of gastric emptying in humans by cholecystokinin. J Clin Incest 1986;77: 992–996.
24. Kleibeuker JH, Beekhuis H, Piers DA et al. Retardation of gastric emptying of solid food by sekretin. Gastroenterology 1988;94: 122–126.
25. Miedema BW, van Heerden JA, Nagorney DM et al. Complications following pancreaticoduodenectomy. Current management. Arch Surg 1992;127:945–949.
26. Yeo CJ, Barry MK, Kauter PK et al. Erythromycin accelerates gastric emptying after pancreaticoduodenectomy. A prospective, randomized, placebo-controlled trial. Ann Surg 1993;218:229–237.
27. Ohwada S, Satoh Y, Kawate S et al. Low-dose erythromycin reduces delayed gastric emptying and improves gastric motility after Billroth I pylorus-preserving pancreatoduodenectomy. Ann Surg 2001;234:668–674.
28. Van Berge Henegouwen MI, van Gulik TM, Akkermans LM et al. The effect of octreotid on gastric emptying at dosage used to prezent complications after pancreatic surgery: a randomised, placebo controlled study in volunteers. Gut 1997;41:758–762.
29. Yeo CJ, Cameron JL, Lellemoe KD et al. Does prophylactic octreotide decrease the rates of pancreratic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomised placebo-controlled trial. Ann Surg 2000;232: 419–429.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2012 Číslo 8
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole vs. Tramadol in Postoperative Analgesia
- Spasmolytic Effect of Metamizole
Najčítanejšie v tomto čísle
- Complications of breast augmentation – a case report
- Surgical treatment of liver metastases of gastric cancer
- Delayed gastric emptying after partial duodenopancreatectomy
- Injury to the abdominal wall by a foreign body with a late perforation of the GIT