Primary delayed gastric emptying after pylorus-resecting pancreatoduodenectomy: A matched-pair comparison of Roux-en-Y vs. Billroth-II reconstruction

Felix O Hofmann; Victoria S Engelstädter; Ughur Aghamaliyev; Mathilda M Knoblauch; Elise Pretzsch; Maximilian Weniger; Jan G D'Haese; Bernhard W Renz; Jens Werner; Matthias Ilmer

doi:10.1016/j.sopen.2024.10.005

Primary delayed gastric emptying after pylorus-resecting pancreatoduodenectomy: A matched-pair comparison of Roux-en-Y vs. Billroth-II reconstruction

Surg Open Sci. 2024 Oct 31:22:46-52. doi: 10.1016/j.sopen.2024.10.005. eCollection 2024 Dec.

Authors

Felix O Hofmann^{1

2}, Victoria S Engelstädter¹, Ughur Aghamaliyev¹, Mathilda M Knoblauch^{1

2}, Elise Pretzsch^{1

2}, Maximilian Weniger^{1

2}, Jan G D'Haese^{1

3}, Bernhard W Renz^{1

2}, Jens Werner¹, Matthias Ilmer^{1

2}

Affiliations

¹ Department of General, Visceral and Transplantation Surgery, Ludwig-Maximilians-University Hospital Munich, Marchioninistrasse 15, 81377 Munich, Germany.
² German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany.
³ Department of General, Visceral and Vascular Surgery, Agatharied Hospital, Hausham, Germany.

Abstract

Background: After pylorus-resecting pancreatoduodenectomy (PrPD), delayed gastric emptying (DGE) might partially be attributed to biliary reflux. We investigated whether the incidence of primary DGE is reduced after Roux-en-Y instead of Billroth-II reconstruction.

Methods: Patients undergoing PrPD from 2016 to 2019 at a high-volume center were identified. Excluding causes of secondary DGE, we matched patients with Roux-en-Y and Billroth-II reconstruction in a 1:2 ratio and compared primary DGE.

Results: In 24 vs. 48 (Roux-en-Y vs. Billroth-II) patients, DGE (grade B/C) incidence (20.8 % vs. 18.8 %; P = 1.000), nasogastric tube requirement (median 2 vs. 2 days; P = 0.844) and time to solid food intake (7 vs. 7 days; P = 0.933) were comparable. Univariable logistic regression showed no association between DGE and Roux-en-Y reconstruction (OR 1.47; P = 0.524), in contrast to age (1.08; P = 0.030) and pancreatic biochemical leak (4.98; P = 0.007).

Conclusions: Primary DGE did not differ between Roux-en-Y and Billroth-II reconstruction after PrPD. Instead, age and postoperative pancreatic biochemical leak were associated with higher DGE risk.

Keywords: Billroth-II reconstruction; Delayed gastric emptying; Pancreatic ductal adenocarcinoma; Pylorus-resecting partial pancreatoduodenectomy; Roux-en-Y reconstruction.