Factors influencing delayed gastric emptying after pancreaticoduodenectomy - a meta-analysis.

BACKGROUND/AIMS: Delayed gastric emptying (DGE) is the most frequent postoperative complication after pancreaticoduodenectomy. Not only does it contribute considerably to prolonged hospitalization, but it is also associated with increased postoperative morbidity and mortality. We performed a meta-analysis to assess factors influencing the development of DGE after pancreaticoduodenectomy.

METHODOLOGY: We systematically searched for studies that assessed association between peri-operative factors and DGE. We reviewed separately each of the factors, including preservation of pylorus, methods of gastrointestinal reconstruction, postoperative enteral feeding and postoperative complications. We identified 1035 studies published between May 1, 1988 and May 1, 2008.

RESULTS

Compared with control subjects, the risk of DGE was 2.35 for preservation of pylorus (95% CI, 0.72 to 7.61), 6.14 for postoperative complications (95% CI, 3.47 to 10.85). There was no significant association between the occurrence of DGE with either PD or PPPD.

CONCLUSIONS

Postoperative enteral feeding did not show any advantages in preventing DGE. Postoperative complications were the most important factor associated with DGE’s occurrence. Antecolic and BII type gastrojejunostomy seems to suggest an improvement in the incidence of DGE.