Delayed gastric emptying after pancreaticoduodenectomy and pancreaticogastrostomy

Objective: To find out which factors influence the development of delayed g astric emptying (DGE) after pancreaticoduodenectomy with pancreaticogastros tomy. Design: Prospective clinical study. Setting: University hospital, France. Subjects: 88 patients of 103 consecutive patients who had had pancreaticodu odenectomies, November 1991-November 1997. Intervention: Whipple resection, and parenteral and enteral nutrition. Main outcome measures: Mortality, morbidity, and development of DGE (define d as the need for a postoperative nasogastric tube for 10 days or longer). Results: One patient died, and 44 developed postoperative complications. 36 patients (41%) developed DGE in 21 of whom (58%. 24% of the total) it was in isolation, with no other complication; and 52 (59%) did not. There were significant differences between those who developed DGE and those who did n ot: 30 men (83%) compared with 6 women (17%) developed DGE compared with 32 (62%) and 20 (38%) (p = 0.03;); 15 (42%) developed a complication as well as DGE compared with 8 (15%) (p = 0.005); 10 (28%) who developed DGE requir ed reoperation compared with 4 (8%) (p = 0.011)); mean (SD) hospital stay w as 30 (12) days among those with DGE compared with 17 (5) days (p = 0.0001) ; and their mean (SD) serum protein concentration on day 1 was 46 (1) compa red with 51 (7) g/L (p = 0.01), Multivariate analysis showed that three fac tors independently influenced the development of DGE: sex (p = 0.01), the n eed for reoperation (1,= 0.03) and the mean serum protein concentration on day 1 (p = 0.04). Conclusion: Postoperative complication and the need for reoperation remain the most common factors linked to the development of DGE. However. in a qua rter of patients DGE was not associated with any postoperative complication .