Abstracts
2002 Digestive Disease Week

# 106680 Abstract ID: 106680 Low Rate of Delayed Gastric Emptying after Pylorus Preserving Duodenopancreatectomy
Hartwig Riediger, Frank Makowiec, Stefan Benz, Stefan Trczeczak, Ulrich Adam, Ulrich T Hopt, Freiburg, Germany; Rostock D-18055, Germany

Background: Delayed gastric emptying (DGE) is a well known complication after duodenopancreatectomy exceeding 20% in some series. We analyzed our single center experience of DGE in a large number of patients undergoing pylorus-preserving duodenopancreatectomy during a seven-year period. Methods: From 1994 to February 2001, 181 patients (67% male) underwent PPDP. Indications for surgery were chronic pancreatitis (47%), pancreatic or periampullary cancer (39%) and other malignant or benign diseases (14%). Most perioperative data including data on postoperative nutrition were documented in a prospective database. Retrocolic end-to-side duodenojejunostomy was performed to the proximal jejunum below the mesocolon. In 74% a nasojejunal (triluminal) feeding tube was placed intraoperatively for early enteral nutrition (started on day 1 or 2 after surgery). Three different definitions of DGE were used in the analysis. DGE10 was defined as inability to tolerate regular diet after postoperative day 10, DGE14 as inability to tolerate regular diet after postoperative day 14 and DGE10GT as need for a nasogastric tube beyond day 10. Uni- and multivariate analysis was used to assess possible risk factors for DGE (17 pre- and intraoperative parameters). Results: Postoperative morbidity was 39%, 30-day mortality 2.8%, median postoperative length of stay 15 days. DGE occurred in 13% (DGE10), 4% (DGE14) and 6,6% (DGE10GT), respectively. In multivariate analysis postoperative complications were a risk factor for DGE (all 3 definitions). After eliminating 18 patients (9.9%), who died or were inable to eat due to reoperation or mechanical ventilation, from further analysis the frequencies of DGE10, DGE14 and DGE10GT were 9.2%, 2.5% and 2.5%, respectively. Multivariate risk factor analysis revealed postoperative complications and increased preoperative creatinine as independent risk factors for DGE10. Due to low frequencies no risk factors were identified for DGE14 or DGE10GT. Early enteral nutrition did not influence the rate of DGE. Conclusions: Although postoperative complications and impaired renal function are risk factors for DGE following PPDP with duodenojejunostomy performed below the mesocolon, DGE plays no relevant role in the absence of other complications which prevent the patients from eating.