American Journal of Internal Medicine

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Slowing of Motor–Evacuation Function of the Stomach After Pancreatoduodenectomy: A Modern Approach to the Problem

Received: 20 August 2023    Accepted: 4 October 2023    Published: 28 October 2023
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Abstract

To investigate the effectiveness of the existing methods of forming anastomoses and to determine the influencing factors on the development of delayed gastric emptying (DGE) or slowing of motor–evacuation function of the stomach. An assessment of the frequency, features of the clinical course of DGE after pancreatoduodenectomy, in cases with underwent pylorus-preserving pancreaticoduodenectomy (PPPD), and pylorus-removing pancreaticoduodenectomy (PrPD), the way of reconstruction of the gastrointestinal tract based on the analysis of the given options for surgical interventions. A retrospective study was conducted of 102 patients between January 2019 and November 2021 who underwent Traverso pylorus-preserving pancreaticoduodenectomy and pylorus-removing pancreaticoduodenectomy. The patients were divided into two groups: I - 26 patients who had delayed gastric emptying and II - 76 patients without symptoms of DGE. complications occurred in 42% (43 patients), and DGE was diagnosed in 25.5% (26) of 102 patients. An postoperative pancreatic fistulas (POPF) was found in 14% (14 patients), and clinically significant fistulas (grades B and C) in 9% (9 patients). Among 26 patients, DGE in 16 patients had the degree of severity A, 8 - B, and 2 - C. The type of gastrojejunostomy (P < 0.05) significantly affects the occurrence of DGE. The type of pancreaticojejunostomy anastomosis (P = 0.85) does not affect the occurrence of delayed evacuation from the stomach. Patients with complications were discharged from the hospital 6 days later on average. General surgical complications (P ≤ 0.001); pancreatic fistula (P <0.05) is significantly associated with a clinically significant delay in DGE; biliary fistulae (P = 0.75), bleeding (P = 0.44) - no correlation was noted. The data obtained from the study of influencing factors are presented in Table 1.

DOI 10.11648/j.ajim.20231104.12
Published in American Journal of Internal Medicine (Volume 11, Issue 4, July 2023)
Page(s) 67-70
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Delayed Gastric Emptying (DGE), Pancreaticoduodenectomy (PD), Pylorus-Removing Pancreaticoduodenectomy (PrPD), Pylorus-Preserving Pancreaticoduodenectomy (PPPD), Postoperative Pancreatic Fistulas (POPF)

References
[1] Dai J, Jiang Y, Fu D. Reducing postoperative complications and improving clinical outcome: Enhanced recovery after surgery in pancreaticoduodenectomy – A retrospective cohort study. International Journal of Surgery. Volume 39, March 2017, Pages 176-181. doi: 10.1016 / j.ijsu.2017.01.089.
[2] Lyu Y, Li T, Wang B, Cheng Y, Zhao S. Selection of pancreaticojejunostomy technique after pancreaticoduodenectomy: duct-to-mucosa anastomosis is not better than invagination anastomosis. Medicine (Baltimore). 2018 Oct; 97 (40): e12621. doi: 10.1097/MD.0000000000012621.
[3] Jing W, Wu S, Gao S, Shi X, Liu W, Ren Y, Ouyang L, Zheng K, Guo S, Wu C, Jin G. Early oral feeding versus nasojejunal early enteral nutrition in patients following pancreaticoduodenectomy: a propensity score-weighted analysis of 428 consecutive patients. Int J Surg. 2023 Sep 25. doi: 10.1097/JS9.0000000000000786.
[4] Noorani A, Rangelova E, Del Chiaro M, Lundell LR, Ansorge C. Delayed Gastric Emptying after Pancreatic Surgery: Analysis of Factors Determinant for the Short-term Outcome. Front Surg. 2016; 3: 25. Published online 2016 Apr 25. doi: 10.3389/fsurg.2016.00025.
[5] Panwar R, Pal S. The International Study Group of Pancreatic Surgery definition of delayed gastric emptying and the effects of various surgical modifications on the occurrence of delayed gastric emptying after pancreatoduodenectomy. Hepatobiliary Pancreat Dis Int. 2017 Aug 15; 16 (4): 353-363. doi: 10.1016/S1499-3872(17)60037-7.
[6] Cai X, Zhang M, Liang Ch, Xu Y, Yu W. Delayed gastric emptying after Pancreaticoduodenectomy: a propensity score-matched analysis and clinical Nomogram study. BMC Surg. 2020 Jul 9; 20 (1): 149. doi: 10.1186/s12893-020-00809-5
[7] Sahora K, Morales-Oyarvide V, Thayer SP, Ferrone CHR, Warshaw AL, Lillemoe KD, et al. The effect of antecolic versus retrocolic reconstruction on delayed gastric emptying after classic non-pylorus-preserving pancreaticoduodenectomy. Am J Surg. 2015 Jun; 209 (6): 1028-35. doi: 10.1016/j.amjsurg.2014.04.015.
[8] Jin Y, Feng YY, Qi XG, Hao G, Yu YQ, Li JT, et al. Pancreatogastrostomy vs pancreatojejunostomy after pancreaticoduodenectomy: an updated meta-analysis of RCTs and our experience. World J Gastrointest Surg. 2019; 11: 322–332. doi: 10.4240/wjgs.v11.i7.322.
[9] Werba G, Sparks AD, Lin PP, Johnson LB, Vaziri K. The PrEDICT-DGE score as a simple preoperative screening tool identifies patients at increased risk for delayed gastric emptying after pancreaticoduodenectomy. HPB (Oxford) 2022; 24 (1): 30–39. doi: 10.1016/j.hpb.2021.06.417.
[10] Francken MFG, van Roessel S, Swijnenburg R-J, Erdmann JI, Busch OR, Dijkgraaf MGW, et al. Hospital costs of delayed gastric emptying following pancreatoduodenectomy and the financial headroom for novel prophylactic treatment strategies. HPB (Oxford) 2021; 23 (12): 1865–1872. doi: 10.1016/j.hpb.2021.04.025.
[11] Camilleri M, Sanders KM. Gastroparesis. Gastroenterology. 2022; 162 (1): 68–87.e1. doi: 10.1053/j.gastro.2021.10.028.
[12] Hayama S, Senmaru N, Hirano S. Delayed gastric emptying after pancreatoduodenectomy: comparison between invaginated pancreatogastrostomy and pancreatojejunostomy. BMC Surg 2020; 20: 60. 10.1186/s12893-020-00707-w.
[13] Shyr BU, Chen SC, Shyr YM, Wang SE. Surgical, survival, and oncological outcomes after vascular resection in robotic and open pancreaticoduodenectomy. Surg Endosc. 2020; 34 (1): 377–383. doi: 10.1007/s00464-019-06779-x.
[14] Okabayashi T, Sui K, Murokawa T, et al. Indications for pancreaticoduodenectomy affected postoperative outcomes in octogenarians. Ann Gastroenterol Surg. 2021; 5 (1): 102–110. doi: 10.1002/ags3.12395.
[15] Huang Y, Damodaran Prabha R, Chua TC, et al. Safety and efficacy of pancreaticoduodenectomy in octogenarians. Front Surg. 2021; 8: 617286. doi: 10.3389/fsurg.2021.617286.
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    Oleksandr Usenko, Volodymyr Kopchak, Oleksandr Lytvyn, Andrii Deinychenko, Serhii Motelchuk, et al. (2023). Slowing of Motor–Evacuation Function of the Stomach After Pancreatoduodenectomy: A Modern Approach to the Problem. American Journal of Internal Medicine, 11(4), 67-70. https://doi.org/10.11648/j.ajim.20231104.12

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    ACS Style

    Oleksandr Usenko; Volodymyr Kopchak; Oleksandr Lytvyn; Andrii Deinychenko; Serhii Motelchuk, et al. Slowing of Motor–Evacuation Function of the Stomach After Pancreatoduodenectomy: A Modern Approach to the Problem. Am. J. Intern. Med. 2023, 11(4), 67-70. doi: 10.11648/j.ajim.20231104.12

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    AMA Style

    Oleksandr Usenko, Volodymyr Kopchak, Oleksandr Lytvyn, Andrii Deinychenko, Serhii Motelchuk, et al. Slowing of Motor–Evacuation Function of the Stomach After Pancreatoduodenectomy: A Modern Approach to the Problem. Am J Intern Med. 2023;11(4):67-70. doi: 10.11648/j.ajim.20231104.12

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  • @article{10.11648/j.ajim.20231104.12,
      author = {Oleksandr Usenko and Volodymyr Kopchak and Oleksandr Lytvyn and Andrii Deinychenko and Serhii Motelchuk and Polad Azadov and Sophia Khachaturova},
      title = {Slowing of Motor–Evacuation Function of the Stomach After Pancreatoduodenectomy: A Modern Approach to the Problem},
      journal = {American Journal of Internal Medicine},
      volume = {11},
      number = {4},
      pages = {67-70},
      doi = {10.11648/j.ajim.20231104.12},
      url = {https://doi.org/10.11648/j.ajim.20231104.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20231104.12},
      abstract = {To investigate the effectiveness of the existing methods of forming anastomoses and to determine the influencing factors on the development of delayed gastric emptying (DGE) or slowing of motor–evacuation function of the stomach. An assessment of the frequency, features of the clinical course of DGE after pancreatoduodenectomy, in cases with underwent pylorus-preserving pancreaticoduodenectomy (PPPD), and pylorus-removing pancreaticoduodenectomy (PrPD), the way of reconstruction of the gastrointestinal tract based on the analysis of the given options for surgical interventions. A retrospective study was conducted of 102 patients between January 2019 and November 2021 who underwent Traverso pylorus-preserving pancreaticoduodenectomy and pylorus-removing pancreaticoduodenectomy. The patients were divided into two groups: I - 26 patients who had delayed gastric emptying and II - 76 patients without symptoms of DGE. complications occurred in 42% (43 patients), and DGE was diagnosed in 25.5% (26) of 102 patients. An postoperative pancreatic fistulas (POPF) was found in 14% (14 patients), and clinically significant fistulas (grades B and C) in 9% (9 patients). Among 26 patients, DGE in 16 patients had the degree of severity A, 8 - B, and 2 - C. The type of gastrojejunostomy (P < 0.05) significantly affects the occurrence of DGE. The type of pancreaticojejunostomy anastomosis (P = 0.85) does not affect the occurrence of delayed evacuation from the stomach. Patients with complications were discharged from the hospital 6 days later on average. General surgical complications (P ≤ 0.001); pancreatic fistula (P <0.05) is significantly associated with a clinically significant delay in DGE; biliary fistulae (P = 0.75), bleeding (P = 0.44) - no correlation was noted. The data obtained from the study of influencing factors are presented in Table 1.},
     year = {2023}
    }
    

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  • TY  - JOUR
    T1  - Slowing of Motor–Evacuation Function of the Stomach After Pancreatoduodenectomy: A Modern Approach to the Problem
    AU  - Oleksandr Usenko
    AU  - Volodymyr Kopchak
    AU  - Oleksandr Lytvyn
    AU  - Andrii Deinychenko
    AU  - Serhii Motelchuk
    AU  - Polad Azadov
    AU  - Sophia Khachaturova
    Y1  - 2023/10/28
    PY  - 2023
    N1  - https://doi.org/10.11648/j.ajim.20231104.12
    DO  - 10.11648/j.ajim.20231104.12
    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
    SP  - 67
    EP  - 70
    PB  - Science Publishing Group
    SN  - 2330-4324
    UR  - https://doi.org/10.11648/j.ajim.20231104.12
    AB  - To investigate the effectiveness of the existing methods of forming anastomoses and to determine the influencing factors on the development of delayed gastric emptying (DGE) or slowing of motor–evacuation function of the stomach. An assessment of the frequency, features of the clinical course of DGE after pancreatoduodenectomy, in cases with underwent pylorus-preserving pancreaticoduodenectomy (PPPD), and pylorus-removing pancreaticoduodenectomy (PrPD), the way of reconstruction of the gastrointestinal tract based on the analysis of the given options for surgical interventions. A retrospective study was conducted of 102 patients between January 2019 and November 2021 who underwent Traverso pylorus-preserving pancreaticoduodenectomy and pylorus-removing pancreaticoduodenectomy. The patients were divided into two groups: I - 26 patients who had delayed gastric emptying and II - 76 patients without symptoms of DGE. complications occurred in 42% (43 patients), and DGE was diagnosed in 25.5% (26) of 102 patients. An postoperative pancreatic fistulas (POPF) was found in 14% (14 patients), and clinically significant fistulas (grades B and C) in 9% (9 patients). Among 26 patients, DGE in 16 patients had the degree of severity A, 8 - B, and 2 - C. The type of gastrojejunostomy (P < 0.05) significantly affects the occurrence of DGE. The type of pancreaticojejunostomy anastomosis (P = 0.85) does not affect the occurrence of delayed evacuation from the stomach. Patients with complications were discharged from the hospital 6 days later on average. General surgical complications (P ≤ 0.001); pancreatic fistula (P <0.05) is significantly associated with a clinically significant delay in DGE; biliary fistulae (P = 0.75), bleeding (P = 0.44) - no correlation was noted. The data obtained from the study of influencing factors are presented in Table 1.
    VL  - 11
    IS  - 4
    ER  - 

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Author Information
  • Department of Thoracic-Abdominal Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine

  • Department of Pancreatic and Bile Ducts Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine

  • Department of Pancreatic and Bile Ducts Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine

  • Department of Pancreatic and Bile Ducts Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine

  • Department of Pancreatic and Bile Ducts Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine

  • Department of Pancreatic and Bile Ducts Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine

  • Department of Pancreatic and Bile Ducts Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine

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