Delayed Gastric Emptying After Pancreaticoduodenectomy: Is Subtotal Stomach Preserving Better or Pylorus Preserving?

Mena Hanna, Rahul Gadde, Leonardo Tamariz, Casey Allen, Jonathan Meizoso, Danny Sleeman, Alan Livingstone, Danny Yakoub

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Delayed gastric emptying (DGE) is one of the main complications after pancreaticoduodenectomy (PD). Literature review and meta-analysis were used to evaluate whether subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) may have less incidence than pylorus-preserving pancreaticoduodenectomy (PPPD). Methods: Online search for studies comparing PPPD to SSPPD was done. Primary outcome was DGE. Quality of included studies was evaluated and heterogeneity was assessed. Relative risk (RR) and 95 % confidence intervals (CI) were calculated from pooled data in RCTs and retrospective studies. Results: Eight studies met our selection criteria, with a total of 663 patients undergoing pancreaticoduodenectomy; 309 underwent PPPD and 354 underwent SSPPD. Median age was 66 years. Average male/female ratio was 57 vs. 43 %, respectively. There was lower incidence of DGE with SSPPD (RR 0.527; 95 % CI 0.363–0.763; p < 0.001) and less nasogastric tube days with SSPPD (RR −0.544; 95 % CI −876 to −0.008; p = 0.047). Operative blood loss was more in SSPPD (RR 0.285; 95 % CI 0.071–0.499; p = 0.009). There was no statistical difference between the two groups regarding length of hospital stay, incidence of pancreatic fistula, abscesses, overall morbidity, or postoperative mortality. Conclusion: SSPPD was associated with less DGE than PPPD. Larger prospective randomized studies are needed to investigate the association of this result with other complications in more depth.

Original languageEnglish (US)
Pages (from-to)1542-1552
Number of pages11
JournalJournal of Gastrointestinal Surgery
Volume19
Issue number8
DOIs
StatePublished - Aug 25 2015
Externally publishedYes

Fingerprint

Pancreaticoduodenectomy
Gastric Emptying
Pylorus
Stomach
Confidence Intervals
Length of Stay
Incidence
Pancreatic Fistula
Abscess
Patient Selection
Meta-Analysis

All Science Journal Classification (ASJC) codes

  • Surgery
  • Gastroenterology

Cite this

Delayed Gastric Emptying After Pancreaticoduodenectomy : Is Subtotal Stomach Preserving Better or Pylorus Preserving? / Hanna, Mena; Gadde, Rahul; Tamariz, Leonardo; Allen, Casey; Meizoso, Jonathan; Sleeman, Danny; Livingstone, Alan; Yakoub, Danny.

In: Journal of Gastrointestinal Surgery, Vol. 19, No. 8, 25.08.2015, p. 1542-1552.

Research output: Contribution to journalArticle

Hanna, Mena ; Gadde, Rahul ; Tamariz, Leonardo ; Allen, Casey ; Meizoso, Jonathan ; Sleeman, Danny ; Livingstone, Alan ; Yakoub, Danny. / Delayed Gastric Emptying After Pancreaticoduodenectomy : Is Subtotal Stomach Preserving Better or Pylorus Preserving?. In: Journal of Gastrointestinal Surgery. 2015 ; Vol. 19, No. 8. pp. 1542-1552.
@article{2046c33d362c4c62af47e66afeadf2c6,
title = "Delayed Gastric Emptying After Pancreaticoduodenectomy: Is Subtotal Stomach Preserving Better or Pylorus Preserving?",
abstract = "Background: Delayed gastric emptying (DGE) is one of the main complications after pancreaticoduodenectomy (PD). Literature review and meta-analysis were used to evaluate whether subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) may have less incidence than pylorus-preserving pancreaticoduodenectomy (PPPD). Methods: Online search for studies comparing PPPD to SSPPD was done. Primary outcome was DGE. Quality of included studies was evaluated and heterogeneity was assessed. Relative risk (RR) and 95 {\%} confidence intervals (CI) were calculated from pooled data in RCTs and retrospective studies. Results: Eight studies met our selection criteria, with a total of 663 patients undergoing pancreaticoduodenectomy; 309 underwent PPPD and 354 underwent SSPPD. Median age was 66 years. Average male/female ratio was 57 vs. 43 {\%}, respectively. There was lower incidence of DGE with SSPPD (RR 0.527; 95 {\%} CI 0.363–0.763; p < 0.001) and less nasogastric tube days with SSPPD (RR −0.544; 95 {\%} CI −876 to −0.008; p = 0.047). Operative blood loss was more in SSPPD (RR 0.285; 95 {\%} CI 0.071–0.499; p = 0.009). There was no statistical difference between the two groups regarding length of hospital stay, incidence of pancreatic fistula, abscesses, overall morbidity, or postoperative mortality. Conclusion: SSPPD was associated with less DGE than PPPD. Larger prospective randomized studies are needed to investigate the association of this result with other complications in more depth.",
author = "Mena Hanna and Rahul Gadde and Leonardo Tamariz and Casey Allen and Jonathan Meizoso and Danny Sleeman and Alan Livingstone and Danny Yakoub",
year = "2015",
month = "8",
day = "25",
doi = "10.1007/s11605-015-2816-1",
language = "English (US)",
volume = "19",
pages = "1542--1552",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",
number = "8",

}

TY - JOUR

T1 - Delayed Gastric Emptying After Pancreaticoduodenectomy

T2 - Is Subtotal Stomach Preserving Better or Pylorus Preserving?

AU - Hanna, Mena

AU - Gadde, Rahul

AU - Tamariz, Leonardo

AU - Allen, Casey

AU - Meizoso, Jonathan

AU - Sleeman, Danny

AU - Livingstone, Alan

AU - Yakoub, Danny

PY - 2015/8/25

Y1 - 2015/8/25

N2 - Background: Delayed gastric emptying (DGE) is one of the main complications after pancreaticoduodenectomy (PD). Literature review and meta-analysis were used to evaluate whether subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) may have less incidence than pylorus-preserving pancreaticoduodenectomy (PPPD). Methods: Online search for studies comparing PPPD to SSPPD was done. Primary outcome was DGE. Quality of included studies was evaluated and heterogeneity was assessed. Relative risk (RR) and 95 % confidence intervals (CI) were calculated from pooled data in RCTs and retrospective studies. Results: Eight studies met our selection criteria, with a total of 663 patients undergoing pancreaticoduodenectomy; 309 underwent PPPD and 354 underwent SSPPD. Median age was 66 years. Average male/female ratio was 57 vs. 43 %, respectively. There was lower incidence of DGE with SSPPD (RR 0.527; 95 % CI 0.363–0.763; p < 0.001) and less nasogastric tube days with SSPPD (RR −0.544; 95 % CI −876 to −0.008; p = 0.047). Operative blood loss was more in SSPPD (RR 0.285; 95 % CI 0.071–0.499; p = 0.009). There was no statistical difference between the two groups regarding length of hospital stay, incidence of pancreatic fistula, abscesses, overall morbidity, or postoperative mortality. Conclusion: SSPPD was associated with less DGE than PPPD. Larger prospective randomized studies are needed to investigate the association of this result with other complications in more depth.

AB - Background: Delayed gastric emptying (DGE) is one of the main complications after pancreaticoduodenectomy (PD). Literature review and meta-analysis were used to evaluate whether subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) may have less incidence than pylorus-preserving pancreaticoduodenectomy (PPPD). Methods: Online search for studies comparing PPPD to SSPPD was done. Primary outcome was DGE. Quality of included studies was evaluated and heterogeneity was assessed. Relative risk (RR) and 95 % confidence intervals (CI) were calculated from pooled data in RCTs and retrospective studies. Results: Eight studies met our selection criteria, with a total of 663 patients undergoing pancreaticoduodenectomy; 309 underwent PPPD and 354 underwent SSPPD. Median age was 66 years. Average male/female ratio was 57 vs. 43 %, respectively. There was lower incidence of DGE with SSPPD (RR 0.527; 95 % CI 0.363–0.763; p < 0.001) and less nasogastric tube days with SSPPD (RR −0.544; 95 % CI −876 to −0.008; p = 0.047). Operative blood loss was more in SSPPD (RR 0.285; 95 % CI 0.071–0.499; p = 0.009). There was no statistical difference between the two groups regarding length of hospital stay, incidence of pancreatic fistula, abscesses, overall morbidity, or postoperative mortality. Conclusion: SSPPD was associated with less DGE than PPPD. Larger prospective randomized studies are needed to investigate the association of this result with other complications in more depth.

UR - http://www.scopus.com/inward/record.url?scp=84937972452&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84937972452&partnerID=8YFLogxK

U2 - 10.1007/s11605-015-2816-1

DO - 10.1007/s11605-015-2816-1

M3 - Article

C2 - 25862001

AN - SCOPUS:84937972452

VL - 19

SP - 1542

EP - 1552

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

SN - 1091-255X

IS - 8

ER -