Pathophysiology after pancreaticoduodenectomy

Table 2 Incidence of delayed gastric emptying according to different gastrointestinal reconstructive methods following pancreaticoduodenectomy

Ref.	Year	Study design	Primary end point	Observations
Eshuis et al[81]	2014	In PPPD Antecolic (n = 125) vs Retrocolic (n = 121)	DGE	No differences in DGE (45 patients (36%) vs 41 (34%), absolute risk difference: 2.1% (95%CI: -9.8-14.0) No differences in need for postoperative nutritional support, other complications, hospital mortality, and median length of hospital stay
Tamandl et al[82]	2014	In PPPD, antecolic (n = 36) vs retrocolic (n = 28)	DGE	No differences in DGE (17.6% vs 23.1%, P = 0.628) No differences in length of hospital stay [13.0 (10.0-17.5) vs 12.5 (11.0-17.0) days; P = 0.446], time to regular diet [5 (5-7) d vs 5 (4-6) d, P = 0.353], and NG tube requirement [4 (3-7) d vs 3 (3-5) d, P = 0.600]
Imamura et al[83]	2014	In PPPD, antecolic (n = 58) vs vertical retrocolic (n = 58)	DGE	No difference in DGE (12.1% vs 20.7%, P = 0.316) At postoperative 6 mo, DGE was accelerated in antecolic group At postoperative 12 mo, better postoperative weight recovery in vertical retrocolic group (93.8% ± 1.2% vs 98.5 % ± 1.3%, P = 0.015)
Tani et al[84]	2014	In PD, Conventional (n = 76) vs Isolated Roux-en-Y (n = 77)	POPF/DGE	No differences in DGE and POPF POPF: conventional (34%) vs isolated Roux-en-Y (33%), P = 0.909 DGE: conventional (12%) vs isolated Roux-en-Y (15%), P = 0.609
Shimoda et al[85]	2013	In SSPPD, Billroth II (n = 52) vs Roux-en-Y (n = 49)	DGE	Lower DGE in Billroth II: (5.7% vs 30.4%, P = 0.028) Shorter hospital stay in Billroth II (31.6 ± 15.0 d vs 41.4 ± 20.5 d, P = 0.037) Significant association between POPF and DGE (P = 0.037)
Ke et al[86]	2013	In PD	DGE/POPF	No differences in DGE and POPF
		Continuous loop (n = 109) vs Roux-en-Y (n = 107)		POPF: continuous loop (17.6%) vs Roux-en-Y (15.7%), P > 0.05 DGE: continuous loop (25%) vs Roux-en-Y (23%), P > 0.05
Gangavatiker et al[87]	2011	In conventional PD and PPPD Antecolic (n = 32) vs Retrocolic (n = 36)	DGE	No difference in DGE (34.4% vs 27.8%, P = 0.6)
Kurahara et al[88]	2011	In SSPPD, Antecolic (n = 24) vs retrocolic (n = 22)	DGE	Lower incidence of DGE in the antecolic group [20.8% vs 50%, P = 0.0364, especially in the incidence of DGE grade B/C (4.2% vs 27.3%, P = 0.0234)] Significantly shorter time to full resumption of diet in antecolic group No significant difference in other postoperative complications
Chijiiwa et al[89]	2009	In PPPD, Antecolic (n = 17) vs retrocolic (n = 18)	DGE	No difference in DGE DGE: 6% vs 22%, P = 0.34

PPPD: Pylorus-preserving pancreaticoduodenectomy; DGE: Delayed gastric emptying; PD: Pancreaticoduodenectomy; POPF: Postoperative pancreatic fistula.