Case Control Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2019; 11(2): 93-100
Published online Feb 27, 2019. doi: 10.4240/wjgs.v11.i2.93
Dual loop (Roux en Y) reconstruction with isolated gastric limb reduces delayed gastric emptying after pancreatico-duodenectomy
Offir Ben-Ishay, Reem Abu Zhaya, Yoram Kluger
Offir Ben-Ishay, Reem Abu Zhaya, Yoram Kluger, Surgical Oncology Unit, Division of General Surgery, Rambam Health Care Campus, Haifa 35254, Israel
Author contributions: Ben-Ishay O contributed to study conception and design, statistics, drafting of the manuscript; Zhaya RA contributed to data collection; Kluger Y contributed to critical review of the manuscript.
Institutional review board statement: This study was approval by RMB-16-0581.
Informed consent statement: The study was exempt from informed consent by the institutional review board committee due to its retrospective nature and the lack of clinical impact on the patients involved in the study.
Conflict-of-interest statement: The authors report no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Offir Ben-Ishay, MD, Director, Doctor, Surgical Oncology Unit, Division of General Surgery, Rambam Health Care Campus, 8 Ha’Aliyah St., Haifa 35254, Israel. o_ben-ishay@rambam.health.gov.il
Telephone: +972-4-8541730 Fax: +972-4-8542321
Received: February 9, 2019
Peer-review started: February 11, 2019
First decision: February 19, 2019
Revised: February 23, 2019
Accepted: February 24, 2019
Article in press: February 25, 2019
Published online: February 27, 2019
Processing time: 17 Days and 21 Hours
Abstract
BACKGROUND

Single loop reconstruction (SLR) was routine in our institution for patients undergoing pancreatico-duodenectomy (PD). Roux-en Y reconstruction with an isolated gastric limb (RIGL) recently became the reconstruction of choice.

AIM

To evaluate the impact of RIGL on incidence and severity of delayed gastric emptying (DGE).

METHODS

This is a single institution, retrospective analysis of patients undergoing PD. All patients undergoing PD from July 2010 through December 2016 were included in the study. Outcome of RIGL were compared to SLR. Primary measure of outcome included incidence and severity of DGE. Secondary measures of outcome were overall complications and postoperative mortality.

RESULTS

One hundred and seventy-nine patients were included in the study. Fifty-two had RIGL, 127 had SLR. Overall complication rate was 40.2%, patients in the RIGL group experienced lower rates of DGE (15.4% vs 59.1%, P = 0.001). Other patient related outcomes were also significantly reduced: day of nasogastric tube removal (3 vs 5, P < 0.001), regain of normal diet (8 vs 9, P < 0.001). On multivariate analysis RIGL was associated independently with reduced rates of DGE (P < 0.001, OR 0.14)

CONCLUSION

The current study shows that RIGL reduces the rate of DGE after PD. Further prospective randomized controlled trials are required to affirm the current data.

Keywords: Pancreaticoduodenectomy; Delayed gastric emptying; Complications; Roux en Y

Core tip: This single institution retrospective analysis showed that patients undergoing pancreatico-duodenectomy with reconstruction in a roux en Y with isolated gastric limb fashion have significantly reduced rates of delayed gastric emptying with no change in operative postoperative and oncological outcome. This type of reconstruction may improve patient’s quality of life and reduces patient's related costs.