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Improvement of early delayed gastric emptying in patients with Billroth I type of reconstruction after pylorus preserving pancreatoduodenectomy
Author(s) -
Ueno Tomio,
Takashima Motonari,
Iida Michihisa,
Yoshida Shin,
Suzuki Nobuaki,
Oka Masaaki
Publication year - 2009
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/s00534-009-0054-1
Subject(s) - pylorus , medicine , gastric emptying , pancreaticoduodenectomy , billroth ii , billroth i , gastroenterology , general surgery , stomach , gastrectomy , cancer , pancreas
Background Early delayed gastric emptying (DGE) is the most common complication after pylorus‐preserving pancreatoduodenectomy (PpPD). Recently, a vertical antecolic reconstruction for duodenojejunostomy was recommended to decrease the incidence of early DGE in patients with Billroth II‐type reconstruction after PpPD. However, Billroth I‐type reconstruction (B‐I) after PpPD is still favored in Japan. Methods Twelve consecutive patients with B‐I were prospectively enrolled. Our technique includes an end‐to‐side duodenojejunostomy and alignment of the stomach contours with fixation of the greater omentum to the abdominal wall in order to promote passage from the stomach through the jejunal loop. DGE was evaluated according to the consensus definition of the International Study Group of Pancreatic Surgery (ISGPS). Results DGE was absent, with the nasogastric tube removed within 3 days in all patients. Mean duration of nasogastric tube placement was 1.5 ± 0.4 days. Mean maximum suction volume was 85 ± 32 ml/day. Conclusion Preliminary results were encouraging simply with relief of the outflow disturbance around the duodenojejunostomy in patients with B‐I after PpPD. These findings warrant further prospective randomized trials at either multiple or high‐volume centers.