Abstracts
1998 Digestive Disease Week

#1024

DELAYED GASTRIC EMPTYING OCCURS AFTER BOTH CLASSICAL AND PYLORUS-PRESERVING WHIPPLE PROCEDURE. A Andrén-Sandberg, M Wagner, HU Baer, W Uhl, H Friess and MW Büchler. Department of Visceral and Transplantation Surgery, University Hospital of Bern, Switzerland.

Background: Delayed gastric emptying (DGE) after pancreatic head resection confers a serious nutritional problem to patients who often already have faced substantial weight loss prior to surgery. The reasons for the disturbed gastric motility are not yet fully understood. Aim of the study and methods: We compared the incidence of gastric emptying delay after pancreatic resection in a prospectively collected, consecutive and recent material. All pancreatic resections were done with a well standardized technique and 95% of all procedures were carried out by 3 surgeons. DGE was defined if there was at least 500 ml gastric secretion per day through a nasogastric tube for more than 5 days. If the nasogastric tube drained less than 500 ml per day, the tube was removed and patients were allowed to drink ad libitum. Results: From 11/1993 to 11/1997 271 patients underwent pancreatic resection (15 total pancreatectomies and 8 local excisions excluded). There were 44 classical Whipple, 95 pylorus-preserving Whipple, 92 duodenum-preserving and 40 left resections. Overall morbidity was 30% (patients) and mortality was 1.5% in the whole series. In total, 29 patients (11%) developed DGE; 20 had pancreatic neoplasm, 6 had periampullary tumors and 3 had chronic pancreatitis. In these patients, the nasogastric tube remained for 11 days on average (range 5 to 40 days). In the DGE group, morbidity (DGE excluded) was 34% (patients) and mortality was 0. The incidence of DGE was 25% (n=11) after classical Whipple resection and 19% (n=18) after pylorus-preserving resection (p = 0.41). There was no occurrence of DGE in patients undergoing duodenum-preserving or left resection. One patient was reoperated due to persistent DGE, all the other patients were treated conservatively. Conclusions: Despite well-standardized technique in an referral center, there is a substantial presence of DGE in patients undergoing classical or pylorus-preserving resection. There was no difference in the incidence of DGE between these two methods of resection. All DGEs were transient and could be treated by a conservative regime in all cases but one.

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