Details

Autor(en) / Beteiligte

• Eshuis, Wietse J
• van Eijck, Casper H J
• Gerhards, Michael F
• Coene, Peter P
• de Hingh, Ignace H. J T
• Karsten, Thom M
• Bonsing, Bert A
• Gerritsen, Josephus J. G M
• Bosscha, Koop
• Spillenaar Bilgen, Ernst J
• Haverkamp, Jorien A
• Busch, Olivier R C
• van Gulik, Thomas M
• Reitsma, Johannes B
• Gouma, Dirk J

Titel

Antecolic Versus Retrocolic Route of the Gastroenteric Anastomosis After Pancreatoduodenectomy: A Randomized Controlled Trial

Ist Teil von

• Annals of surgery, 2014-01, Vol.259 (1), p.45-51

Ort / Verlag

United States: by Lippincott Williams & Wilkins

Erscheinungsjahr

2014

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• OBJECTIVE:To investigate the relationship between the route of gastroenteric (GE) reconstruction after pancreatoduodenectomy (PD) and the postoperative incidence of delayed gastric emptying (DGE). BACKGROUND:DGE is one of the most common complications after PD. Recent studies suggest that an antecolic route of the GE reconstruction leads to a lower incidence of DGE, compared to a retrocolic route. In a nonrandomized comparison within our trial center, we found no difference in DGE after antecolic or retrocolic GE reconstruction. METHODS:Ten middle- to high-volume centers participated in the patient inclusion. Patients scheduled for PD who gave written informed consent were included and randomized during surgery after resection. Standard operation was a pylorus-preserving PD. Primary endpoint was DGE. Secondary endpoints included other complications and length of hospital stay. RESULTS:There were 125 patients in the retrocolic group, and 121 patients in the antecolic group. Baseline and treatment characteristics did not differ between the study groups. In the retrocolic group, 45 patients (36%) developed clinically relevant DGE compared with 41 (34%) in the antecolic group (absolute risk difference2.1%; 95% confidence interval−9.8% to 14.0%). There were no differences in need for postoperative (par)enteral nutritional support, other complications, hospital mortality, and median length of hospital stay. CONCLUSIONS:The route of GE reconstruction after PD does not influence the postoperative incidence of DGE or other complications. The etiology and treatment of DGE, which occurs frequently after both procedures, need further investigation. The GE reconstruction after PD should be routed according to the surgeonʼs preference.