A reduction in delayed gastric emptying by classic pancreaticoduodenectomy with an antecolic gastrojejunal anastomosis and a retrogastric omental patch

Background: Delayed gastric emptying (DGE) continues to be a major cause of morbidity following pancreaticoduodenectomy (PD). A change in the method of reconstruction following PD was instituted in an attempt to reduce the incidence DGE. Methods - Patients undergoing PD from January 2002 to December 2008 were reviewed and outcomes determined. Pylorus-preserving pancreaticoduodenectomy (PPPD) with a retrocolic duodenojejunal anastomosis (n=79) or a classic PD with a retrocolic gastrojejunostomy (n=36) was performed prior to January 2008. Thereafter, a classic PD with an antecolic gastrojejunal anastomosis and placement of a retrogastric vascular omental patch was undertaken (n=36). Results - A statistically significant decrease in DGE was noted in the antecolic group compared to the entire retrocolic group (14% vs 40%; p=0.004) and compared to patients treated by classic PD with a retrocolic anastomosis alone (14% vs 39%; p=0.016). On multivariate analysis, the only modifiable factor associated with reduced DGE was the antecolic technique with an omental patch, odds ratio (OR) 0.3 (confidence interval (CI) 0.1-0.8) p=0.022. Male gender was associated with an increased risk of DGE with OR 2.3 (CI 1.1-4.8) p=0.026. Conclusion - A classic PD combined with an antecolic anastomosis and retrogastric vascular omental patch results in a significant reduction in DGE.