Delayed Gastric Emptying Clinical Trial
Surgical resection in periampullary cancer using pancreaticoduodenectomy is the most
important modality in the treatment. In the past, pancreaticoduodenectomy was associated with
high morbidity and mortality. However, with the advances in techniques, including
perioperative patient management, development of antibiotics, diagnostic radiology, and
interventional treatments, pancreaticoduodenectomy is now considered a safe and feasible
operation. Postoperative complication rates are reported to be in 10 to 20% in experienced
hospitals and operation related mortality is at about 1%. Therefore, surgical treatment for
periampullary cancer is actively considered.
However, postoperative complications, such as postoperative pancreatic fistula, (POPF)
delayed gastric emptying, intraabdominal abscess, and postoperative bleeding, are still
serious complications. Among these complications, delayed gastric emptying is considered less
critical. However, delayed gastric emptying (DGE) can cause poor oral intake, which in turn,
may lead to delay in recovery of postoperative nutritional state and in severe cases,
requires insertion of levine tube and long-term fasting.
There have been many hypotheses for cause of DGE after pancreaticoduodenectomy, but definite
cause have not been discovered yet. With the introduction of pylorus-preserving
pancreaticoduodenectomy (PPPD), incidences of DGE were initially reported to have increased.
However, results of most randomized comparative studies had concluded that PPPD and PD have
no significance in occurence of DGE.
One hypothesis for cause of DGE we present here has to do with anatomic positioning of
anastomosis site, especially pancreatojejunostomy (PJ) and duodenojejunostomy (DJ), after
PPPD. Reconstruction after PPPD positions PJ and DJ close to each other. PJ site is often
associated with one of postoperative complications, POPF. POPF may create inflammation around
PJ site and pancreatitis, which may lead to severe adhesion around PJ as a secondary change.
This adhesion and inflammation may cause DJ, which is located near PJ, to be pulled towards
PJ site. When DJ is pulled towards PJ site, distal DJ site can become angulated and gastric
contents may not beadle to pass easily. Gastric contents may be stagnated in stomach and
thereby causing DGE. Therefore, in this study, we will fixate DJ on transverse colon using
sutures, and prevent possibility of angulation of DJ. This additional procedure may reduce
occurence of DGE.
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