Effect of standardizing the incision line on delayed gastric emptying after laparoscopic gastrectomy: A retrospective preliminary analysis

Background: The use of totally laparoscopic surgery with Billroth-I reconstruction (delta-shaped anastomosis) has rapidly become widespread in recent years. However, we experienced delayed gastric emptying (DGE) in the early period after introduction of this technique. To the best of our knowledge, there are no report mentioned the incision line to prevent DGE in distal gastrectomy. In the present study, we standardized the surgical techniques, including the gastric incision line and compared the short-term results before and after standardization. Methods: A total of 86 patients were enrolled in this study. 28 procedures were performed in the early period and 58 procedures were performed in the late period, and the 2 groups were compared retrospectively. Results: The operation time decreased significantly after standardization from 288 min to 224 min (P < 0.001). The median value of perioperative bleeding volume reduced from 22.5 mL to 12.5 mL (P =0.060). There were no postoperative complications related to the site of anastomosis in either group. 5 cases of DGE (17.8%) was noted in the early period, but only 2 cases (3.4%) in the late period (P =0.022). Conclusions: Standardization of the incision line after laparoscopic gastrectomy resulted in a decline in incidence of DGE.

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Comparison of surgical outcomes between isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy after pancreaticoduodenectomy: A systematic review and meta-analysis

10.21203/rs.3.rs-17682/v1 ◽

2020 ◽

Author(s):

lyu yunxiao ◽

Bin Wang ◽

Yunxiao Cheng ◽

Yueming Xu ◽

WeiBing Du

Keyword(s):

Gastric Emptying ◽

Pancreatic Fistula ◽

Delayed Gastric Emptying ◽

Operation Time ◽

Major Complication ◽

Bile Leakage ◽

Postoperative Pancreatic Fistula ◽

Controlled Trials ◽

Cochrane Central Register ◽

Major Complications

Abstract Background We aimed to compare the safety and effectiveness of the following procedures after pancreaticoduodenectomy: isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy. Methods We performed a systematic search of the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 January 2020. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using STATA 12.0 statistical software.Results Thirteen studies involving 1942 patients were included in this study. Pooled analysis showed that the major complication and reoperation rates following isolated pancreaticojejunostomy were lower than with conventional pancreaticojejunostomy (OR=0.35, 95% CI: 0.13–0.96, P=0.04 and OR=0.36, 95% CI: 0.15–0.86, p=0.02, respectively), and that isolated pancreaticojejunostomy required longer operation time vs conventional pancreaticojejunostomy (WMD=43.61, 95% CI: 21.64–65.58, P=0.00). Regarding postoperative pancreatic fistula, clinically-relevant postoperative pancreatic fistula, delayed gastric emptying, clinically-relevant delayed gastric emptying, bile leakage, hemorrhage , reoperation, length of postoperative hospital stay, major complications, overall complications, and mortality, we found no significant differences for either isolated pancreaticojejunostomy versus conventional pancreaticojejunostomy or isolated gastrojejunostomy versus conventional pancreaticojejunostomy. Conclusions This study showed that isolated pancreaticojejunostomy was associated with fewer major complications and a lower reoperation rate, but required longer operation time vs conventional pancreaticojejunostomy. Considering the limitations, high-quality randomized controlled trials are required.

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Inhibitory effect of ileal oleate on postprandial motility of the upper gut

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.1991.261.3.g458 ◽

1991 ◽

Vol 261 (3) ◽

pp. G458-G463 ◽

Cited By ~ 2

Author(s):

Z. Dreznik ◽

D. Brocksmith ◽

T. A. Meininger ◽

N. J. Soper

Keyword(s):

Oleic Acid ◽

Gastric Emptying ◽

Gamma Camera ◽

Delayed Gastric Emptying ◽

Early Period ◽

Inhibitory Effect ◽

Myoelectric Activity ◽

Phenol Red ◽

Mixed Meal ◽

Postprandial Motility

To determine the effect of ileal oleate on postprandial gastrointestinal motility, duodenal and paired perfusion-aspiration ileal catheters and bipolar duodenal and jejunal electrodes were surgically implanted in five dogs. The ileum was perfused with either saline or an isotonic oleic acid emulsion at 2 ml/min. A 205-kcal mixed meal containing 120 ml liquid nutrient labeled with 111In-diethylenetriamine pentaacetic acid (DTPA) and solid food labeled with 99mTc was then administered orally. Gastric emptying was assessed by a gamma camera, myoelectric activity was continuously monitored, and duodenal-ileal transit of phenol red was determined over the ensuing 240 min. Ileal oleate reduced duodenal spikeburst frequency by 50% (P less than 0.05) and delayed gastric emptying of liquids and solids. Four hours after ingesting the meal, 62% of solids and 34% of liquids were retained in the stomach during oleic acid perfusion compared with 25 and 4%, respectively, when saline was perfused (P less than 0.05). Duodenal-ileal transit was markedly slowed by ileal perfusion with the oleic acid emulsion (P less than 0.001). Ileal oleate therefore exerted a profound inhibitory effect on proximal gut motility in the early period after ingestion of a mixed-nutrient meal in dogs.

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Surgical Techniques to Prevent Delayed Gastric Emptying After Esophagectomy With Gastric Interposition: A Systematic Review

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2014.06.057 ◽

2014 ◽

Vol 98 (4) ◽

pp. 1512-1519 ◽

Cited By ~ 33

Author(s):

Ronald D.L. Akkerman ◽

Leonie Haverkamp ◽

Richard van Hillegersberg ◽

Jelle P. Ruurda

Keyword(s):

Systematic Review ◽

Gastric Emptying ◽

Delayed Gastric Emptying ◽

Surgical Techniques

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Comparison of surgical outcomes between isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy after pancreaticoduodenectomy: A systematic review and meta-analysis

10.21203/rs.3.rs-17682/v2 ◽

2020 ◽

Author(s):

lyu yunxiao ◽

Bin Wang ◽

Yunxiao Cheng ◽

Yueming Xu ◽

WeiBing Du

Keyword(s):

Gastric Emptying ◽

Pancreatic Fistula ◽

Delayed Gastric Emptying ◽

Meta Analysis ◽

Operation Time ◽

Bile Leakage ◽

Reoperation Rate ◽

Postoperative Pancreatic Fistula ◽

Controlled Trials ◽

Cochrane Central Register

Abstract Background We aimed to compare the safety and effectiveness of the following procedures after pancreaticoduodenectomy: isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy.Methods We performed a systematic search of the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 January 2020. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using STATA 12.0 statistical software.Results Thirteen studies involving 1942 patients were included in this study. Pooled analysis showed that reoperation rates following isolated pancreaticojejunostomy were lower reoperation than with conventional pancreaticojejunostomy (OR=0.36, 95% CI: 0.15–0.86, p=0.02, respectively), and that isolated pancreaticojejunostomy required longer operation time vs conventional pancreaticojejunostomy (WMD=43.61, 95% CI: 21.64–65.58, P=0.00). Regarding postoperative pancreatic fistula, clinically-relevant postoperative pancreatic fistula, delayed gastric emptying, clinically-relevant delayed gastric emptying, bile leakage, hemorrhage, reoperation, length of postoperative hospital stay, major complications, overall complications, and mortality, we found no significant differences for either isolated pancreaticojejunostomy versus conventional pancreaticojejunostomy or isolated gastrojejunostomy versus conventional pancreaticojejunostomy.Conclusions This study showed that isolated pancreaticojejunostomy was associated with a lower reoperation rate, but required longer operation time vs conventional pancreaticojejunostomy. Considering the limitations, high-quality randomized controlled trials are required.

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