Abstract：
BACKGROUND:Delayed gastric emptying (DGE) is a common serious problem after pancreaticoduodenectomy (PD). Flange gastrojejunostomy (FL-GE) is a previously described technique that creates an internal flange in a hand-sewn gastroenterostomy. Results of FL-GE on incidence and severity of DGE after PD are presented. STUDY DESIGN:Data were extracted from a prospective database of PD. Standard PD with antrectomy were performed with flange gastroenterostomy (FL-GE) or other techniques (NonFL-GE) at a single institution. The International Study Group of Pancreatic Surgery (ISGPS) definition of DGE was used, and DGE severity was graded based on the ISGPS grading system and the Modified Accordion Grading System (MAGS). RESULTS:There were 215 standard PDs performed. Sixty-eight (32%) were FL-GE and 147 (68%) were NonFL-GE. Delayed gastric emptying rates in FL-GE and NonFL-GE were 9% and 23%, respectively (p = 0.012). Differences in severity of DGE were even more prominent: 29% of DGEs in the NonFL-GE group were ISGPS grade C vs 0% in FL-GE. Also, 35% of DGEs in the NonFL-GE group were MAGS 3 vs 0% in FL-GE. Because of some differences in sex and inflammatory complications between groups, a propensity score analysis was performed, creating 57 matched patients in the FL-GE and NonFL-GE groups. The incidence of DGE remained significantly different in the groups (5% in FL-GE vs 18% in NonFL-GE; p = 0.039). CONCLUSIONS:In this cohort study, the flange technique was associated with a marked reduction in the incidence of DGE after PD.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Khan AS,Williams G,Woolsey C,Liu J,Fields RC,Doyle MMB,Hawkins WG,Strasberg SMdoi
10.1016/j.jamcollsurg.2017.06.006subject
Has Abstractpub_date
2017-10-01 00:00:00pages
498-507issue
4eissn
1072-7515issn
1879-1190pii
S1072-7515(17)30565-3journal_volume
225pub_type
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