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Effect of billroth II or Roux-en-Y reconstruction for the gastrojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: a randomized controlled study.
Ann Surg 2013; 257(5):938-42AnnS

Abstract

OBJECTIVE

Delayed gastric emptying (DGE) is one of the major complications after pancreaticoduodenectomy (PD), occurring in 14% to 61% of cases. There have been no studies that compare the incidence of DGE in terms of the reconstruction method of gastrojejunostomy performed in subtotal stomach-preserving pancreaticoduodenectomy (SSPPD). The objective of this study was to evaluate the superiority of Billroth II (B-II) to Roux-en Y (R-Y) reconstruction on decreasing the incidence of delayed gastric emptying DGE after SSPPD by a prospective randomized controlled trial.

METHODS

Between April 2008 and August 2011, 101 patients who underwent SSPPD for pancreatic head or periampullary diseases were randomly allocated to B-II reconstruction (n = 52) and R-Y reconstruction (n = 49) groups. The primary endpoint was incidence of DGE.

RESULTS

DGE occurred in 5.7% of patients in the B-II group and in 20.4% of patients in the R-Y group (P = 0.028). Patients in the B-II group had a significantly shorter hospital stay after operation than patients in the R-Y group (31.6 ± 15.0 days vs. 41.4 ± 20.5 days, P = 0.037). In terms of postoperative complications, the incidence of pancreatic fistula was significantly higher in patients with DGE (38.5%) than in patients without DGE (14.8%) (P = 0.037).

CONCLUSION

It is suggested that the incidence of DGE after SSPPD can be decreased by using B-II rather than R-Y reconstruction for gastrojejunostomy.(Clinical Trials Registry, UMIN-CTR: http://www.umin.ac.jp/ctr/, ref no. UMIN000003535).

Authors+Show Affiliations

Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan. guido.torzilli@unimi.itNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

23579543

Citation

Shimoda, Mitsugi, et al. "Effect of Billroth II or Roux-en-Y Reconstruction for the Gastrojejunostomy On Delayed Gastric Emptying After Pancreaticoduodenectomy: a Randomized Controlled Study." Annals of Surgery, vol. 257, no. 5, 2013, pp. 938-42.
Shimoda M, Kubota K, Katoh M, et al. Effect of billroth II or Roux-en-Y reconstruction for the gastrojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: a randomized controlled study. Ann Surg. 2013;257(5):938-42.
Shimoda, M., Kubota, K., Katoh, M., & Kita, J. (2013). Effect of billroth II or Roux-en-Y reconstruction for the gastrojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: a randomized controlled study. Annals of Surgery, 257(5), pp. 938-42. doi:10.1097/SLA.0b013e31826c3f90.
Shimoda M, et al. Effect of Billroth II or Roux-en-Y Reconstruction for the Gastrojejunostomy On Delayed Gastric Emptying After Pancreaticoduodenectomy: a Randomized Controlled Study. Ann Surg. 2013;257(5):938-42. PubMed PMID: 23579543.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of billroth II or Roux-en-Y reconstruction for the gastrojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: a randomized controlled study. AU - Shimoda,Mitsugi, AU - Kubota,Keiichi, AU - Katoh,Masato, AU - Kita,Junji, PY - 2013/4/13/entrez PY - 2013/4/13/pubmed PY - 2013/6/5/medline SP - 938 EP - 42 JF - Annals of surgery JO - Ann. Surg. VL - 257 IS - 5 N2 - OBJECTIVE: Delayed gastric emptying (DGE) is one of the major complications after pancreaticoduodenectomy (PD), occurring in 14% to 61% of cases. There have been no studies that compare the incidence of DGE in terms of the reconstruction method of gastrojejunostomy performed in subtotal stomach-preserving pancreaticoduodenectomy (SSPPD). The objective of this study was to evaluate the superiority of Billroth II (B-II) to Roux-en Y (R-Y) reconstruction on decreasing the incidence of delayed gastric emptying DGE after SSPPD by a prospective randomized controlled trial. METHODS: Between April 2008 and August 2011, 101 patients who underwent SSPPD for pancreatic head or periampullary diseases were randomly allocated to B-II reconstruction (n = 52) and R-Y reconstruction (n = 49) groups. The primary endpoint was incidence of DGE. RESULTS: DGE occurred in 5.7% of patients in the B-II group and in 20.4% of patients in the R-Y group (P = 0.028). Patients in the B-II group had a significantly shorter hospital stay after operation than patients in the R-Y group (31.6 ± 15.0 days vs. 41.4 ± 20.5 days, P = 0.037). In terms of postoperative complications, the incidence of pancreatic fistula was significantly higher in patients with DGE (38.5%) than in patients without DGE (14.8%) (P = 0.037). CONCLUSION: It is suggested that the incidence of DGE after SSPPD can be decreased by using B-II rather than R-Y reconstruction for gastrojejunostomy.(Clinical Trials Registry, UMIN-CTR: http://www.umin.ac.jp/ctr/, ref no. UMIN000003535). SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/23579543/Effect_of_billroth_II_or_Roux_en_Y_reconstruction_for_the_gastrojejunostomy_on_delayed_gastric_emptying_after_pancreaticoduodenectomy:_a_randomized_controlled_study_ L2 - http://Insights.ovid.com/pubmed?pmid=23579543 DB - PRIME DP - Unbound Medicine ER -