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Type of gastrointestinal reconstruction affects postoperative recovery after pancreatic head resection
Author(s) -
Kawamoto Masahiko,
Konomi Hiroyuki,
Kobayashi Kiichiro,
Shimizu Shuji,
Yamaguchi Koji,
Tanaka Masao
Publication year - 2006
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s00534-005-1085-x
Subject(s) - medicine , duodenum , pancreatic head , motility , gastrostomy , gastric emptying , stomach , surgery , gastroenterology , resection , biology , genetics
Abstract Background/Purpose The postoperative recovery of gastric motility with various reconstructions after pancreatic head resection has been reported. However, little is known about this recovery after pancreatic head resection with segmental duodenectomy (PHRSD). Some have attributed gastric stasis after pylorus‐preserving pancreatoduodenectomy (PPPD) to tube gastrostomy, but its effect on gastric motility has not been investigated. In this study, the postoperative recovery after PHRSD and PPPD, and gastric motility with and without gastrostomy after PPPD were investigated. Methods We analyzed the first appearance of gastric phase III motility, postoperative systemic status, and body weight (BW; n = 32). The Imanaga PPPD and PHRSD were compared because the procedures differ only in the length of the remaining duodenum. Traverso and Roux‐en‐Y PPPDs were compared because the two procedures are similar except for the creation of gastrostomy. Results (1) Times to first appearance of gastric phase III motility and BW recovery were significantly better after PHRSD than after the Imanaga PPPD ( P < 0.05). (2) Times to first gastric phase III motility and resumption of a regular diet as well as periods of gastric sump tube use and postoperative hospital stay were significantly shorter after the Roux‐en‐Y than after the Traverso PPPD ( P < 0.05). Conclusions Preservation of as long a portion of the duodenum as possible, the choice of a Roux‐en‐Y duodenojejunostomy, and the avoidance of peritoneal fixation of the gastric wall may be factors that improve the recovery of gastric motility and BW after pancreatic head resection.