Delayed gastric emptying after pancreaticoduodenectomy and pancreaticogastrostomy.

OBJECTIVE

To find out which factors influence the development of delayed gastric emptying (DGE) after pancreaticoduodenectomy with pancreaticogastrostomy.

DESIGN

Prospective clinical study.

SETTING

University hospital, France.

SUBJECTS: 88 patients of 103 consecutive patients who had had pancreaticoduodenectomies, November 1991-November 1997.

INTERVENTIONS: Whipple resection, and parenteral and enteral nutrition.

MAIN OUTCOME MEASURES: Mortality, morbidity, and development of DGE (defined as the need for a postoperative nasogastric tube for 10 days or longer).

RESULTS

One patient died, and 44 developed postoperative complications. 36 patients (41%) developed DGE in 21 of whom (58%, 24% of the total) it was in isolation, with no other complication; and 52 (59%) did not. There were significant differences between those who developed DGE and those who did not: 30 men (83%) compared with 6 women (17%) developed DGE compared with 32 (62%) and 20 (38%) (p = 0.03;); 15 (42%) developed a complication as well as DGE compared with 8 (15%) (p = 0.005); 10(28%) who developed DGE required reoperation compared with 4(8%) (p = 0.011); mean (SD) hospital stay was 30(12) days among those with DGE compared with 17 (5) days (p= 0.0001); and their mean (SD) serum protein concentration on day 1 was 46 (1) compared with 51 (7) g/L (p=0.01). Multivariate analysis showed that three factors independently influenced the development of DGE: sex (p = 0.01), the need for reoperation (p = 0.03) and the mean serum protein concentration on day 1 (p = 0.04).

CONCLUSION

Postoperative complication and the need for reoperation remain the most common factors linked to the development of DGE. However, in a quarter of patients DGE was not associated with any postoperative complication.