Clinical Analysis Of Postsurgical Gastroparesis Syndrome After Pancreaticoduodenectomy

Objective: This paper is designed to investigate and analyze the diagnose, treatment and prevention of postsurgical gastroparesis syndrome(PGS) after pancreatoduodenectomy(classical whipple procedure).Methods:Clinical data of 36 patients who underwent pancreaticoduodenectomy by the same group of surgeons from January 2004 to December 2009 were retrospectively analyzed in No.208 Hospital of the Chinese People's Liberation Army from January.Results:There were 8 patients occurred postsurgical gastroparesis syndrome after pancreatoduodenectomy among 36 patients.The prevalence was 22.2%(8/36).The main symptoms of PGS were epigastric fullness,nausea,vomiting (severe after diet),the increasing drainage of nasogastric tube and no bellyache.Most of the patients had normal bowel movement function.Upper gastrointestinal radiography using meglucamine diatrizoate showed decrease or disappearance of gastric peristalsis.Gastroscopy showed that a large amout of residual gastric content and anastomosis edema were found.However,the gastroscope could be passed through the anastomotic stoma without difficulty.All the patients were cured by the drain of nasogastric tube, enteral or parenteral nutrition support, maintaining water-electrolyte balance, actively controlling the levels of blood glucose and providing the prokinetic agents etc. No patients were taken reoperation.Conclusions:1. PGS after pancreatoduodenectomy is induced by multiple factors. We think it is closely related with the reconstruction of gastrointestinal tract, operation time, the complexity of surgery, the pancreas leaks,the bile leakage and celiac infection.2. The diagnosis of PGS depend mainly on clinical symptoms. Upper gastrointestinal radiography and Gastroscopy is reliable diagnostic method.3. The patients can be cured by non-operative therapy. 4. The important methods to prevent PGS after pancreatoduodenectomy include reasonable operation of pancreaticojejunostomy and choledochojejunostomy as well as the unblocked drainage of the operation area.5. Use of the improved Roux-en-y technique for reconstruction following pancreatoduodenectomy may decrease the incidence of PGS. Future randomized control trials are recommended to further evaluate the efficacy of the procedure.