Impact of pylorus preservation on delayed gastric emptying after pancreaticoduodenectomy—analysis of 5,000 patients based on the German StuDoQ|Pancreas-Registry

Tim Fahlbusch, Andreas Minh Luu, Philipp Höhn, Carsten Klinger, Jens Werner, Tobias Keck, Helmut Friess, Jörg Köninger, Thomas Kraus, Guido Alsfasser, Winfried Padberg, Jörg Peter Ritz, Waldemar Uhl, Orlin Belyaev

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Background: Delayed gastric emptying (DGE) is one of the most common complications after pancreatic head resection. It leads to increased length of hospital stay, high costs for healthcare systems and reduced quality of life. The primary aim of the study was to assess the impact of pylorus preservation, respectively resection on the occurrence of DGE in patients undergoing pancreaticoduodenectomy (PD). Methods: All cases of pylorus-resecting PD (PRPD) and pylorus-preserving PD (PPPD) entered in the StuDoQ|Pancreas nationwide registry of the German Society of General and Visceral Surgery from 01/01/2014 until 31/12/2018 including demographics, surgical techniques, histopathological and perioperative data were retrospectively analyzed. This study was approved by the ethics committee of the Ruhr-University Bochum, Germany. Results: Data of 5,080 patients were enrolled. PPPD was the method of choice (70.4%). Pylorus preservation had no impact on the occurrence of DGE (20.3% vs. 21.5%, P=0.33), but further risk factors could be identified. The comparison of PPPD and PRPD groups showed statistically significant differences in the surgical approach (primary open approach, 94.8% vs. 98.0%, P<0.001), duration of surgery (326.4 vs. 352.1 minutes, P<0.001), technique of pancreatic anastomosis (pancreaticojejunostomy vs. pancreaticojejunostomy), 78.6% vs. 85.2%, P<0.001). Conclusions: Patient factors, intraoperative factors, duration of surgery and postoperative factors (postoperative pancreatic fistula, biliary leakage and other surgical complications) were identified as risk factors for DGE. Future research should focus on register-based, prospective, randomised-controlled studies such as the currently recruiting “PyloResPres trial”.

Original languageEnglish
Pages (from-to)67-76
Number of pages10
JournalGland Surgery
Volume11
Issue number1
DOIs
StatePublished - Jan 2022
Externally publishedYes

Keywords

  • Pancreatic head resection
  • StuDoQ|Pancreas
  • delayed gastric emptying (DGE)
  • pylorus preservation
  • registry

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