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World J Gastroenterol. Dec 7, 2012; 18(45): 6527-6531
Published online Dec 7, 2012. doi: 10.3748/wjg.v18.i45.6527
Does antecolic reconstruction decrease delayed gastric emptying after pancreatoduodenectomy?
Nadia Peparini, Piero Chirletti
Nadia Peparini, Azienda Sanitaria Locale Roma H, 00043 Rome, Italy
Piero Chirletti, Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy
Author contributions: Peparini N conceived and drafted the manuscript, critically revised the manuscript and gave the final approval; Chirletti P critically revised the manuscript and gave its final approval.
Correspondence to: Nadia Peparini, MD, PhD, Azienda Sanitaria Locale Roma H, via Mario Calò, 5-Ciampino, 00043 Rome, Italy. nadiapeparini@yahoo.it
Telephone: +39-339-2203940 Fax: +39-765-488423
Received: September 17, 2012
Revised: November 4, 2012
Accepted: November 11, 2012
Published online: December 7, 2012
Processing time: 91 Days and 10.1 Hours
Abstract

Delayed gastric emptying (DGE) is a frequent complication after pylorus-preserving pancreatoduodenectomy (PpPD). Kawai and colleagues proposed pylorus-resecting pancreatoduodenectomy (PrPD) with antecolic gastrojejunal anastomosis to obviate DGE occurring after PpPD. Here we debate the reported differences in the prevalence of DGE in antecolic and retrocolic gastro/duodeno-jejunostomies after PrPD and PpPD, respectively. We concluded that the route of the gastro/duodeno-jejunal anastomosis with respect to the transverse colon; i.e., antecolic route or retrocolic route, is not responsible for the differences in prevalence of DGE after pancreatoduodenectomy (PD) and that the impact of the reconstructive method on DGE is related mostly to the angulation or torsion of the gastro/duodeno-jejunostomy. We report a prevalence of 8.9% grade A DGE and 1.1% grade C DGE in a series of 89 subtotal stomach-preserving PDs with Roux-en Y retrocolic reconstruction with anastomosis of the isolated Roux limb to the stomach and single Roux limb to both the pancreatic stump and hepatic duct. Retrocolic anastomosis of the isolated first jejunal loop to the gastric remnant allows outflow of the gastric contents by gravity through a “straight route”.

Keywords: Antecolic reconstruction; Retrocolic reconstruction; Pancreatoduodenectomy; Pylorus-preserving pancreatoduodenectomy; Delayed gastric emptying