Intraoperative endoluminal pyloromyotomy as a novel approach to reduce delayed gastric emptying after pylorus-preserving
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ORIGINAL ARTICLE
Intraoperative endoluminal pyloromyotomy as a novel approach to reduce delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy—a retrospective study Matthias C. Schrempf 1 & David R. M. Pinto 1 & Johanna Gutschon 1 & Christoph Schmid 2 & Michael Hoffmann 1 & Bernd Geissler 1 & Sebastian Wolf 1 & Florian Sommer 1 & Matthias Anthuber 1 Received: 21 August 2020 / Accepted: 1 October 2020 # The Author(s) 2020
Abstract Background Delayed gastric emptying (DGE) is one of the most common complications after pylorus-preserving partial pancreaticoduodenectomy (ppPD). The aim of this retrospective study was to assess whether an intraoperative pyloromyotomy during ppPD prior to the creation of duodenojejunostomy reduces DGE. Methods Patients who underwent pylorus-preserving pancreaticoduodenectomy between January 2015 and December 2017 were divided into two groups on the basis of whether an intraoperative pyloromyotomy was performed (pyloromyotomy (PM) group) or not (no pyloromyotomy (NP) group). The primary endpoint was DGE according to the ISGPS definition. The confirmatory analysis of the primary endpoint was performed with multivariate analysis. Results One hundred and ten patients were included in the statistical analysis. Pyloromyotomy was performed in 44 of 110 (40%) cases. DGE of any grade was present in 62 patients (56.4%). The DGE rate was lower in the PM group (40.9%) compared with the NP group (66.7%), and pyloromyotomy was associated with a reduced risk for DGE in univariate (OR 0.35, 95% CI 0.16– 0.76; P = 0.008) and multivariate analyses (OR 0.32, 95% CI 0.13–0.77; P = 0.011). The presence of an intra-abdominal complication was an independent risk factor for DGE in the multivariate analysis (OR 5.54, 95% CI 2.00–15.36; P = 0.001). Conclusion Intraoperative endoluminal pyloromyotomy during ppPD was associated with a reduced risk for DGE in this retrospective study. Pyloromyotomy should be considered a simple technique that can potentially reduce DGE rates after ppPD. Keywords Pylorus-preserving pancreaticoduodenectomy . Delayed gastric emptying . Pyloromyotomy . Pancreatic cancer
Introduction Partial pancreaticoduodenectomy (PD) is the standard treatment for resectable tumors of the pancreatic head, the ampulla of Vater, and the distal common bile duct. In the 1970s, Traverso et al. [1, 2] introduced a pylorus-preserving modification (ppPD) which has been shown to be equally effective compared with the classical PD with regard to long-term survival and tumor recurrence. In-hospital mortality rates are less
* Matthias C. Schrempf [email protected] 1
Department of General, Visceral and Transplant Surgery, University Hospital Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany
2
Department of Hematology and Oncology, University Hospital Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
than 5% in high-volume centers, but perioperative morbidity remains high for PD and ppPD [3, 4]. One of the most common complications after either PD or ppPD is delayed ga
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