Delayed gastric emptying (DGE) is a frequent complication after pylorus-preserving pancreaticoduodenectomy (PPPD). Among others the location of pylorojejunostomy and the presence of other surgical complications may influence the occurrence of DGE. Since definitions of DGE varied largely in the past, the International Study Group of Pancreatic Surgery (ISGPS) recently proposed a standardized classification of DGE 2007 into grade A (no clinical relevance) and grade B and C (clinically relevant). We, therefore, analyzed our experience with DGE after more than 400 PPPDs using the new ISGPS-classification. Methods: Since 1996 420 PPPDs were performed for pancreatic cancer (36%), extrapancreatic periampullary cancer (25%), chronic pancreatitis (28%) or others (11%). The pylorojejunostomy was always performed in retrocolic fashion, abdominal drains were always placed. Prokinetic drugs were only given in the case of DGE. In almost all cases postoperative feeding was started at day one after the operation via enteral feeding tubes and gradually replaced by regular oral diet. The perioperative data were recorded in our pancreatic surgery database (including complete data on gastric tubes and nutrition). Results: Complication rates after 420 PPPDs were 54% (any), 36% (surgery-related), 19% (infectious), 16% (pancreatic leak) and 10% (abdominal abscess). Mortality was 2.9%, reoperation rate for complications 11%. DGE (all grades) occurred in 37% (grade A 25%, grade B 7%, grade C 5%). A clinically relevant DGE (grade B or C; 12%) occurred significantly more frequently in the presence of other complications (DGE B/C in 21% vs. 1% in patients without other complications; p<0.001), with surgical complications (DGE B/C in 26% vs. 4% without surgical complications; p<0.001), with abdominal abscesses (DGE B/C 37% vs. 9% without abscesses; p<0.001) or in patients with a pancreatic leak (DGE B/C 25% vs. 9% without a pancreatic leak; p<0.001). A diabetes (24% of the patients) did not correlate with the occurrence of DGE. Conclusions: As evaluated by the new ISGPS-classification DGE occurred in 37% of the patients after PPPD. However, DGE was of no or minor relevance in about two thirds of the cases. A clinically relevant DGE (grade B/C) almost always correlated with other postoperative complications.