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Reconsideration of Postoperative Oral Intake Tolerance After Pancreaticoduodenectomy: Prospective Consecutive Analysis of Delayed Gastric Emptying According to the ISGPS Definition and the Amount of Dietary Intake

Published on Jun 1, 2009in Annals of Surgery 9.48
· DOI :10.1097/SLA.0b013e3181a63c4c
Emi Akizuki7
Estimated H-index: 7
,
Yasutoshi Kimura36
Estimated H-index: 36
+ 4 AuthorsKoichi Hirata54
Estimated H-index: 54
Cite
Abstract
Objective: A prospective consecutive study was planned to evaluate the postpancreaticoduodenectomy (PD) oral intake tolerance. The occurrence of delayed gastric emptying (DGE), as defined by the International Study Group of Pancreatic Surgery (ISGPS), and the amount of dietary intake were analyzed. The risk factors for low oral intake tolerance were additionally determined. Summary Background Data: The causation of DGE after PD is still unclear. Several possible factors have been discussed, such as reconstruction methods and other complications. However, none of them has followed the definition of ISGPS. Methods: Between 2003 and 2007, 101 consecutive patients underwent PD-related surgery, and standard operative procedure was performed on 85 patients. Perioperative data were prospectively collected in all patients, and the patient’s postoperative dietary intake was recorded for all meals until discharge. As an indicator of early postoperative oral intake tolerance, we added up the dietary intake from postoperative day 1 to 21 and called this value the total amount of dietary intake (TDI). The postoperative outcomes were compared between non-DGE and DGE. The high-low of TDI values was also analyzed. Multivariate analysis for factors associated with the occurrence of DGE and TDI was performed. Results: The occurrence of DGE as defined by ISGPS was 42%. The postoperative outcomes of DGE patients were significantly poor compared with those of non-DGE patients. TDI values were significantly low in DGE patients, and non-DGE patients with low TDI values showed a significantly extended duration of parenteral nutrition and postoperative hospitalization. Operative bleeding (1,000 mL) and pancreatic fistulas were likely to be associated with DGE occurrence. Gender (women), BMI (25 kg/m 2 ), postoperative intraabdominal infection, and DGE were significantly associated with low TDI values. Conclusions: The ISGPS definition of DGE seemed feasible for patient management. TDI values provided additional information for analyzing postoperative oral intake tolerance, especially when describing the differences among non-DGE patients. Substantial risk factors for low oral intake tolerance were high BMI, postoperative intraabdominal infection, and DGE. (Ann Surg 2009;249: 986‐994)
  • References (27)
  • Citations (69)
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References27
Newest
Published on Aug 1, 2008in Ejso 3.38
Otto Kollmar24
Estimated H-index: 24
,
Mohammed R. Moussavian11
Estimated H-index: 11
+ 3 AuthorsMartin K. Schilling39
Estimated H-index: 39
Abstract Aims To evaluate the impact of prophylactic octreotide on gastric emptying in patients undergoing pancreaticoduodenectomy. Postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE) are common complications after pancreaticoduodenectomy. Whereas several prospective randomized trials propose the prophylactic use of octreotide to prevent pancreatic fistula formation, somatostatin has, however, been associated with delayed gastric emptying after partial duodenopancreatectom...
Published on Jul 1, 2008in Journal of Gastrointestinal Surgery 2.69
Emi Akizuki7
Estimated H-index: 7
(Sapporo Medical University),
Yasutoshi Kimura36
Estimated H-index: 36
(Sapporo Medical University)
+ 5 AuthorsKoichi Hirata54
Estimated H-index: 54
(Sapporo Medical University)
Background To determine the influence of pylorus preservation after pancreaticoduodenectomy, we compared the postoperative course of subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) and pylorus-preserving pancreaticoduodenectomy (PPPD).
Published on Jun 1, 2008in Journal of Gastrointestinal Surgery 2.69
Yoshiaki Murakami33
Estimated H-index: 33
(Hiroshima University),
Kenichiro Uemura29
Estimated H-index: 29
(Hiroshima University)
+ 5 AuthorsTaijiro Sueda37
Estimated H-index: 37
(Hiroshima University)
The aim of this study was to identify a preferable procedure reducing the incidence of delayed gastric emptying (DGE) after pylorus-preserving pancreatoduodenectomy (PPPD). Data on 132 consecutive patients with pancreatobiliary disease, who underwent PPPD, were collected retrospectively. A retrocolic Billroth I type reconstruction (B-I group) and an antecolic Roux-en Y type reconstruction (R-Y group) were performed for 54 and 78 patients after PPPD, respectively. Clinical measures of DGE were co...
Published on Feb 1, 2008in Journal of Gastrointestinal Surgery 2.69
Michael G. House35
Estimated H-index: 35
(MSK: Memorial Sloan Kettering Cancer Center),
Yuman Fong107
Estimated H-index: 107
(MSK: Memorial Sloan Kettering Cancer Center)
+ 8 AuthorsMurray F. Brennan140
Estimated H-index: 140
(MSK: Memorial Sloan Kettering Cancer Center)
Background The purpose of this study was to examine the preoperative patient and radiographic factors that are associated with operative morbidity after pancreaticoduodenectomy.
Published on Jan 1, 2008in Journal of the Pancreas
Roger Noun12
Estimated H-index: 12
,
Edward Riachy7
Estimated H-index: 7
+ 7 AuthorsPatricia Yazbeck8
Estimated H-index: 8
Context The effect of obesity on surgical outcome is becoming an increasingly relevant issue given the growing rate of obesity worldwide. Objective To investigate the specific impact of obesity on pancreaticoduodenectomy. Design A retrospective comparative study of a prospectively maintained database was carried out to investigate the specific impact of obesity on the technical aspects and postoperative outcome of pancreaticoduodenectomy. Patients Between 1999 and 2006, 92 consecutive patients u...
Published on Nov 1, 2007in Surgery 3.48
Howard A. Reber56
Estimated H-index: 56
Published on Nov 1, 2007in Surgery 3.48
Moritz N. Wente36
Estimated H-index: 36
(Heidelberg University),
Claudio Bassi79
Estimated H-index: 79
(University of Verona)
+ 9 AuthorsL. William Traverso39
Estimated H-index: 39
(Virginia Mason Medical Center)
Background Delayed gastric emptying (DGE) is one of the most common complications after pancreatic resection. In the literature, the reported incidence of DGE after pancreatic surgery varies considerably between different surgical centers, primarily because an internationally accepted consensus definition of DGE is not available. Several surgical centers use a different definition of DGE. Hence, a valid comparison of different study reports and operative techniques is not possible. Methods After...
Published on Aug 1, 2007in Annals of Surgery 9.48
James T. McPhee18
Estimated H-index: 18
,
Joshua S. Hill17
Estimated H-index: 17
+ 5 AuthorsJennifer F. Tseng36
Estimated H-index: 36
Pancreatic cancer remains the fourth leading cause of cancer deaths overall in the United States, killing an estimated 31,800 people in 2005.1 A number of single-institution and single-state reports have described an improvement in perioperative mortality in the 1980s and 1990s for high-risk cancer resections, including pancreaticoduodenectomy (PD).2–4 In the state of Maryland, concurrent with a move toward statewide regionalization of PD, a decrease in perioperative mortality was described over...
Published on Apr 1, 2007in Journal of The American College of Surgeons 4.45
Emilie Lermite18
Estimated H-index: 18
,
Patrick Pessaux42
Estimated H-index: 42
+ 4 AuthorsArnaud Jp43
Estimated H-index: 43
Background Pancreatic fistula (PF) and delayed gastric emptying (DGE) are, respectively, the most frightening and most frequent complications after pancreaticoduodenectomy (PD). This study was undertaken to determine which independent factors influence the development of PF and DGE after PD. Study Design Between January 1996 and December 2005, 131 consecutive patients underwent a PD with pancreaticogastrostomy. A total of 22 items, entered prospectively, were examined with univariate and multiva...
Published on Feb 1, 2007in Annals of Surgery 9.48
Markus K. Diener31
Estimated H-index: 31
,
Hanns-Peter Knaebel21
Estimated H-index: 21
+ 3 AuthorsChristoph M. Seiler35
Estimated H-index: 35
Objective:Comparison of effectiveness between the pylorus-preserving pancreaticoduodenectomy (“pylorus-preserving Whipple” [PPW]) and the classic Whipple (CW) procedure.Methods:A systematic literature search (Medline, Embase, Cochrane Library, Biosis, Science Citation Index, Ovid Journals) was perfo
Cited By69
Newest
Published on Jun 26, 2019in British Journal of Surgery 5.59
Masayuki Tanaka (Heidelberg University), Max Heckler1
Estimated H-index: 1
(Heidelberg University)
+ 4 AuthorsThilo Hackert34
Estimated H-index: 34
(Heidelberg University)
Published on Apr 1, 2019in Anz Journal of Surgery 1.60
Johan Gagnière8
Estimated H-index: 8
(French Institute of Health and Medical Research),
Bertrand Le Roy5
Estimated H-index: 5
+ 5 AuthorsAurélien Dupré5
Estimated H-index: 5
Monica M. Dua13
Estimated H-index: 13
(Stanford University),
Anand Navalgund1
Estimated H-index: 1
+ 6 AuthorsBrendan C. Visser27
Estimated H-index: 27
(Stanford University)
Limited clinical indicators exist after pancreaticoduodenectomy to allow prediction of delayed gastric emptying (DGE). This study introduces a novel, noninvasive, wireless patch system capable of a...
Published on Jan 1, 2018in Digestive Surgery 1.88
Shinjiro Kobayashi6
Estimated H-index: 6
,
Satoshi Koizumi7
Estimated H-index: 7
+ 3 AuthorsTakehito Otsubo12
Estimated H-index: 12
Published on Jan 1, 2018
Kristoffer Lassen21
Estimated H-index: 21
(Oslo University Hospital),
Olle Ljungqvist67
Estimated H-index: 67
(Örebro University)
Following on the seminal studies on early food after hysterectomies by Ib Hessov [1], the Danish surgeon Henrik Kehlet pioneered the modern emphasis on attenuating surgical trauma and the physiological stress response [2]. The ensuing collaboration with a group of surgeons focussing on nutrition, early recovery and myth busting led to the first Enhanced Recovery After Surgery (ERAS) consensus guidelines for colonic surgery in 2005 [3], updated and expanded in 2009 [4]. The first experiences with...
Published on Dec 1, 2017in Pancreatology 3.24
Kazuki Sasaki3
Estimated H-index: 3
(Osaka University),
Tadafumi Asaoka13
Estimated H-index: 13
(Osaka University)
+ 13 AuthorsKunihito Gotoh23
Estimated H-index: 23
(Osaka University)
Abstract Background/Objectives The gut peptide hormone ghrelin induces appetite and exhibits an anti-inflammatory effect. Serial perioperative changes in ghrelin have been examined in several surgical procedures, but few in pancreatectomy. The present study analyzed perioperative changes in plasma ghrelin levels after pancreaduodenectomy (PD). Methods The study included 24 patients undergoing PD between May 2015 and January 2016 at Osaka University Hospital. Plasma ghrelin and interleukin-6 (IL-...
Published on Sep 1, 2017in Scandinavian Journal of Surgery 1.53
Niloufar Dusch3
Estimated H-index: 3
,
Anja Lietzmann2
Estimated H-index: 2
+ 3 AuthorsTorsten J. Wilhelm7
Estimated H-index: 7
Introduction:The perioperative morbidity following pancreas surgery remains high due to various specific complications: postoperative pancreatic fistula, postpancreatectomy hemorrhage, and delayed gastric emptying. The International Study Group of Pancreatic Surgery has defined these complications. The aim of this study is to evaluate the clinical applicability, to validate the International Study Group of Pancreatic Surgery definition, and to evaluate the postoperative morbidity.Methods:Between...
Rajesh Panwar4
Estimated H-index: 4
(AIIMS: All India Institute of Medical Sciences),
Sujoy Pal17
Estimated H-index: 17
(AIIMS: All India Institute of Medical Sciences)
Background A number of definitions have been used for delayed gastric emptying (DGE) after pancreatoduodenectomy and the reported rates varied widely. The International Study Group of Pancreatic Surgery (ISGPS) definition is the current standard but it is not used universally. In this comprehensive review, we aimed to determine the acceptance rate of ISGPS definition of DGE, the incidence of DGE after pancreatoduodenectomy and the effect of various technical modifications on its incidence. Data ...
Published on Aug 1, 2017in Journal of Hepato-biliary-pancreatic Sciences 2.35
Yasuro Futagawa11
Estimated H-index: 11
(Jikei University School of Medicine),
Masaru Kanehira2
Estimated H-index: 2
(Jikei University School of Medicine)
+ 6 AuthorsK. Yanaga32
Estimated H-index: 32
(Jikei University School of Medicine)
Background Delayed gastric emptying (DGE), a common postoperative complication of pancreaticoduodenectomy, is not considered a life-threatening complication. In the present study, we analyzed the risk factors for DGE and its impact on long-term prognosis. Methods We analyzed 383 patients who underwent pancreaticoduodenectomy between 2003 and 2010, dividing them into two groups according to DGE grade as defined by the International Study Group of Pancreatic Surgery: 243 without DGE (non-DGE group...