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Effect of Antecolic Reconstruction on Delayed Gastric Emptying After the Pylorus-Preserving Whipple Procedure

Published on Nov 1, 2005in Archives of Surgery
· DOI :10.1001/archsurg.140.11.1094
Mark Hartel17
Estimated H-index: 17
,
Moritz N. Wente37
Estimated H-index: 37
+ 5 AuthorsMarkus W. Büchler127
Estimated H-index: 127
Abstract
Hypothesis Antecolic duodenojejunostomy prevents delayed gastric emptying (DGE) after a pylorus-preserving Whipple (ppW) procedure better than retrocolic duodenojejunostomy. Design A single operation team’s experience with antecolic and retrocolic duodenojejunostomy in ppW is analyzed on a prospective database using univariate and multivariate models. Setting Tertiary referral center that focuses on pancreatic diseases. Patients and Interventions One hundred consecutive patients undergoing a ppW procedure with retrocolic reconstruction between January 1, 1996, and December 31, 2001, and 100 consecutive patients undergoing a ppW procedure with antecolic reconstruction between January 1, 2002, and December 31, 2003. Characteristics such as median age, median hospital stay, sex, diagnosis, previous operations, blood loss, surgical and medical complications, American Society of Anesthesiologists risk groups, stent implantation, and especially DGE were matched for the comparison groups. Main Outcome Measures We compared DGE, characteristics, and perioperative variables in patients with antecolic vs retrocolic reconstruction after ppW. Results The DGE occurred significantly more often in patients with retrocolic reconstruction than in those with antecolic reconstruction ( P P  = .25), sex ( P  = .48), and postoperative surgical ( P  = .19) and medical ( P  = .054) complications. The univariate analysis between patients with and without DGE did not show significant differences regarding diagnosis, previous operations, blood loss, surgical and medical complications, American Society of Anesthesiologists classification, or stent implantation. In the multivariate analysis, only the type of reconstruction ( P  = .006) and sex ( P  = .04) seemed to affect DGE. Conclusion We recommend antecolic duodenjejunostomy in patients undergoing a ppW procedure regardless of their diagnosis.
  • References (34)
  • Citations (119)
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References34
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#1Christian Schmidt (IU: Indiana University)H-Index: 39
#2Emilie Susan Powell (IU: Indiana University)H-Index: 12
Last. Fabrizio MichelassiH-Index: 48
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Hypothesis Pancreaticoduodenectomy (PD) is a safe procedure for a variety of periampullary conditions. Design Retrospective review of a prospectively collected database. Setting Academic tertiary care hospital. Patients A total of 516 consecutive patients who underwent PD. Main Outcome Measures Patient outcomes and survival factors. Results Pathological examination demonstrated 57% periampullary cancers, 22% chronic pancreatitis, 12% cystic neoplasms, 4% islet cell neoplasms, and 5% other. Fifty...
295 CitationsSource
#1Markus WagnerH-Index: 26
#2Claudio A. RedaelliH-Index: 25
Last. Markus W. BüchlerH-Index: 127
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Background: Mortality rates associated with pancreatic resection for cancer have steadily decreased with time, but improvements in long-term survival are less clear. This prospective study evaluated risk factors for survival after resection for pancreatic adenocarcinoma. Methods: Data from 366 consecutive patients recorded prospectively between November 1993 and September 2001 were analysed using univariate and multivariate models. Results: Fifty-eight patients (15·8 per cent) underwent surgical...
617 CitationsSource
#1Olaf HorstmannH-Index: 7
#2Peter M. MarkusH-Index: 18
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#1Markus W. BüchlerH-Index: 127
#2Markus WagnerH-Index: 26
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Hypothesis Advances in specialized centers for pancreatic diseases have improved surgical morbidity and outcome. In the past, postoperative local complications (pancreatic fistulae) were causing most of the mortality. Now, more patients experience postoperative complications related to their comorbidity. Design To report a prospective audit of a single center's experience with pancreatic resection during an 8-year period. Setting Tertiary referral center focused on pancreatic diseases. Patients ...
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Last. Howard A. Reber (UCLA: University of California, Los Angeles)H-Index: 59
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Hypothesis After resection of an adenocarcinoma of the ampulla of Vater, certain clinical and pathologic characteristics influence long-term survival. Design Retrospective case series. Setting Major academic medical and pancreatic surgical center. Patients Fifty-five consecutive patients who underwent Whipple resection for ampullary adenocarcinoma from 1988 through 2001. Interventions Pylorus-preserving Whipple resection in 32 patients and standard Whipple resection in 23 patients. Main Outcome ...
83 CitationsSource
#1Markus W. Büchler (University of Bern)H-Index: 127
#2Helmut Friess (University of Bern)H-Index: 64
Last. K. Z'graggen (University of Bern)H-Index: 10
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