DELAYED GASTRIC-EMPTYING AFTER STANDARD PANCREATICODUODENECTOMY VERSUS PYLORUS-PRESERVING PANCREATICODUODENECTOMY - AN ANALYSIS OF 200 CONSECUTIVE PATIENTS

Background: It has been suggested that pylorus-preserving pancreaticod uodenectomy (PPPD) is associated with a high incidence of delayed gast ric emptying and consequently with a prolonged hospital stay compared with standard Whipple's resection, The aim of this prospective study w as to evaluate whether the incidence of delayed postoperative gastric emptying was different after both procedures. Study Design: From 1989 to 1996, 200 consecutive patients underwent pancreatic head resection (100 standard pancreaticoduodenectomy [PD]; 100 PPPD). The groups were compared with regard to patient characteristics, operative indices, p ostoperative morbidity, hospital stay, and mortality. Delayed gastric emptying was defined as nasogastric suction for greater than or equal to 10 days or delay of regular diet until > 14 days postoperatively. R esults: Operative time and blood loss were higher for PD: 6 versus 4.8 hours (p < 0.0001) and 1,580 versus 1,247 mt (p < 0.001), respectivel y. Postoperative morbidity was 48% after PD and 44% after PPPD (not si gnificant [NS]). Hospital mortality was 6% and 1% after PD and PPPD, r espectively (NS). Delayed gastric emptying occurred in 34 patients aft er PD and in 37 after PPPD (NS). Median days of gastric suction was 3 versus 6 days for PD and PPPD (p < 0.0001). A regular diet was tolerat ed after a median of 10 and 11 days for PD and PPPD, respectively (NS) . Postoperative hospital stay was shorter for patients who underwent P PPD: 20 versus 18 days (p < 0.03). Patients with intraabdominal compli cations (n = 52) showed a higher incidence of delayed gastric emptying (p < 0.0001). Conclusions: Our results show that PPPD is a safe proce dure associated with less operative time and blood loss than PD. After PPPD, patients require longer postoperative nasogastric intubation th an after PD, suggesting some form of early postoperative gastric stasi s. There is, however, no difference in the incidence of delayed gastri c emptying or the first postoperative day on which a regular diet is t olerated between these surgical procedures. Intraabdominal complicatio ns are major risk factors for delayed gastric emptying. (C) 1997 by th e American College of Surgeons.