Dual loop (Roux en Y) reconstruction with isolated gastric limb reduces delayed gastric emptying after pancreatico-duodenectomy

Table 1 Comparison of demographic and clinical data between the study and the control group

	RIGL, n = 52	SLR, n = 127	P value
Age	68.2 ± 9.6	68 ± 13.7	0.93
Gender (male)	50 (n = 26)	48.8 (n = 62)	0.89
Risk factors
Smoking	48.7 (n = 19)	35.8 (n = 44)	0.15
Diabetes	32.6 (n = 17)	39.4 (n = 50)	0.4
Chronic pancreatitis	9.6 (n = 5)	9.5 (n = 12)	0.3
Alcohol abuse	8.8 (n = 3)	5.8 (n = 7)	0.5
Clinical presentation
Weight loss	40.4 (n = 21)	55.6 (n = 70)	0.06
Abdominal pain	61.5 (n = 32)	66.7 (n = 84)	0.51
Nausea	23.1 (n = 12)	23 (n = 29)	0.99
Emesis	15.4 (n = 8)	13.5 (n = 17)	0.74
Jaundice	42.3 (n = 22)	51.6 (n = 65)	0.26

RIGL: Roux en y with isolated gastric limb; SLR: Single loop reconstruction.

Table 2 Rate and type of complications within the study and the control group

	RIGL, n = 52	SLR, n = 127	P value
Overall complications	36.5 (n = 19)	41.7 (n = 53)	0.52
Superficial SSI	23.1 (n = 12)	21.3 (n = 27)	0.8
Deep SSI	3.2 (n = 4)	1.9 (n = 1)	0.65
Abscess	15.4 (n = 8)	11 (n = 14)	0.42
POPF	28.9 (n = 15)	29.1 (n = 37)	0.96
Intestinal leak	3.9 (n = 2)	0 (n = 0)	0.03
Bile leak	17.3 (n = 9)	20.5 (n = 26)	0.62
Phlebitis	5.8 (n = 3)	17.3 (n = 22)	0.04
Pneumonia	7.7 (n = 4)	17.3 (n = 22)	0.09
Pulmonary embolism	0 (n = 0)	1.6 (n = 2)	0.53
DVT	0 (n = 0)	0.8 (n = 1)	0.52
PVT	5.8 (n = 3)	3.2 (n = 4)	0.41
CV	9.6 (n = 5)	12.6 (n = 16)	0.57
UTI	7.7 (n = 4)	15 (n = 19)	0.18
Delayed gastric emptying	15.4 (n = 8)	59.1 (n = 75)	< 0.001
Grade A	13.5 (n = 7)	44.9 (n = 57)	< 0.001
Grade B	1.9 (n = 1)	11.8 (n = 15)	< 0.001
Grade C	0	2.4 (n = 3)	NR
Postoperative Mortality	3.9 (n = 2)	5.5 (n = 7)	0.64

RIGL: Roux en y with isolated gastric limb; SLR: Single loop reconstruction; SSI: Surgical site infection; DVT: Deep vein thrombosis, PVT: Portal vein thrombosis; CV: Cardiovascular; UTI: Urinary tract infection; POPF: Postoperative pancreatic fistula; NR: Not report.

Table 3 The study group showed better outcome in terms of all variable related to delayed gastric emptying

	RIGL, n = 52	SLR, n = 127	P value
Day of NG tube extraction (d) (median)	3 (3-4)	5 (4-6)	< 0.001
Length of hospital stay (d) (median)	10 (8-14)	12 (10-18)	0.005
Emesis After feeding tube extraction	0 (n = 0)	19.7 (n = 25)	< 0.001
Need for returning of NG tube	1.9 (n = 1)	24.4 (n = 31)	< 0.001
Day of return to normal diet (d) (median)	8 (6-9)	9 (8-15)	< 0.001

RIGL: Roux en y with isolated gastric limb; SLR: Single loop reconstruction; NG: Naso-gastric tube.

Table 4 Univariate and multivariate analysis of factors associated with delayed gastric emptying

	DGE, n = 83	No DGE, n = 96	Univariate P value	Multivariate P value
Age	67.3 ± 14.5	68.8 ± 10.8	0.4
Gender (female)	59 (n = 49)	43.8 (n = 42)	0.04	0.03
BMI	26.8 ± 4.8	26.1 ± 5	0.39
RIGL (yes)	9.6 (n = 8)	45.8 (n = 44)	0.001	< 0.001
Chronic pancreatitis	8.4 (n = 7)	10.4 (n = 10)	0.58
Alcohol abuse	3.9 (n = 3)	9 (n = 7)	0.19
Pre-existent DM	38.5 (n = 32)	36.5 (n = 35)	0.77
Jaundice	53.7 (n = 44)	44.8 (n = 43)	0.24
Bilirubin total (mg/dL) (median)	1.1 (0.4-4.5)	0.8 (0.4-5.5)	0.84
Malignancy	78.3 (n = 65)	74 (n = 71)	0.5	0.88
Overall complications	49.4 (n = 41)	32.3 (n = 31)	0.019	0.04
Pancreatic leak	26.5 (n = 22)	31.3 (n = 30)	0.48	0.5
Bile leak	22.9 (n = 19)	16.7 (n = 16)	0.29
Pneumonia	20.5 (n = 17)	9.4 (n = 9)	0.03	0.18
Length of hospital stay (d) (median)	14 (11-22)	10 (8-14)	< 0.001
Postoperative mortality	4.8 (n = 4)	5.2 (n = 5)	0.9

BMI: Body Mass index; DM: Diabetes mellitus; DGE: Delayed gastric emptying; RIGL: Roux en y with isolated gastric limb.