Route of gastroenteric reconstruction in pancreatoduodenectomy and delayed gastric emptying

Background: Delayed gastric emptying (DGE) is a frequent complication after pancreatoduodenectomy. Some previous studies suggest that antecolic (compared with retrocolic) gastroenteric reconstruction lowers the incidence of DGE. The present study was performed to investigate the relation between the route of gastroenteric reconstruction and DGE after pancreatoduodenectomy. Methods: In a consecutive series of pancreatoduodenectomies, the route of gastroenteric reconstruction was retrospectively determined. Hospital course was prospectively recorded. Patients with antecolic and retrocolic reconstruction were compared. Primary outcome was DGE (ISGPS definition). Secondary outcomes were other complications and hospital stay. Results: Of 154 included patients, 50% had retrocolic reconstruction. DGE occurred in 58% of retrocolic patients, vs 52% of antecolic patients (NS). 'Primary' DGE (without other intra-abdominal complications) occurred in 36% (retrocolic) and 20% (antecolic) (P = 0.02) of the patients. In multivariable analysis, the route of reconstruction was not associated with primary DGE. Clinically relevant primary DGE (grade B/C) did not differ, nor did the secondary outcomes. Discussion: The incidence of DGE did not differ between the study groups. 'Primary' DGE was more frequent in the retrocolic group, but in multivariable analysis, no association between the route of reconstruction and primary DGE was found. The preferred route for gastroenteric reconstruction after pancreatoduodenectomy remains to be investigated in a well-powered, randomized, controlled trial