Effect of antecolic reconstruction on delayed gastric emptying after the pylorus-preserving Whipple procedure

Hypothesis: Antecolic duodenojejunostomy prevents delayed gastric emptying (DGE) after a pylorus-preserving Whipple (ppW) procedure better than retrocolic duodenojejunostomy. Design: A single operation team's experience with antecolic and retrocolic duodenojejunostomy in ppW is analyzed on a prospective database using univariate and multivariate models. Setting: Tertiary referral center that focuses on pancreatic diseases. Patients and Interventions: One hundred consecutive patients undergoing a ppW procedure with retrocolic reconstruction between January 1, 1996, and December 31, 2001, and 100 consecutive patients undergoing a ppW procedure with antecolic reconstruction between January 1, 2002, and December 31, 2003. Characteristics such as median age, median hospital stay, sex, diagnosis, previous operations, blood loss, surgical and medical complications, American Society of Anesthesiologists risk groups, stent implantation, and especially DGE were matched for the comparison groups. Main Outcome Measures: We compared DGE, characteristics, and perioperative variables in patients with antecolic vs retrocolic reconstruction after ppW. Results: The DGE occurred significantly more often in patients with retrocolic reconstruction than in those with antecolic reconstruction (P<.001). The antecolic and retrocolic study groups were comparable in age (P=.25), sex (P=.48), and postoperative surgical (p=.19) and medical (P=.054) complications. The univariate analysis between patients with and without DGE did not show significant differences regarding diagnosis, previous operations, blood loss, surgical and medical complications, American Society of Anesthesiologists classification, or stent implantation. In the multivariate analysis, only the type of reconstruction (P=.006) and sex (P=.04) seemed to affect DGE. Conclusion: We recommend antecolic duodenjejunostomy in patients undergoing a ppW procedure regardless of their diagnosis.