Pylorus Preserving Pancreaticoduodenectomy Versus Standard Whipple Procedure: Evaluation Of Delayed Gastric Emptying

Objectives:This study aims to compare the clinical outcomes of pylorus-preservingpancreaticoduodenectomy(PPPD) versus standard Whipple pancreaticoduodenectomy(SWPD). The incidence, clinical features as well as associated risk factors of delayed gastricemptying (DGE) were evaluated employing the International Study Group of PancreaticSurgery (ISGPS) consensus definition.Methods:Demographic, pathological and surgical details for76consecutive patients whounderwent PPPD or SWPD at a single institution were analysed using univariate model andmultivariate model.Results:Operation time, blood loss and blood transfusion are less in PPPD group. Resumptionof enteral nutrition, time to passage of gas and stool, gain of weight and hospital dischargewere earlier in PPPD group. Postoperative complications, most of which were post-operativepancreatic fistula (POPF), DGE, wound problems and sepsis, occured in34(44.7%) patientswhich PPPD group counted7and SWPD group27. DGE was diagnosed in17(21.5%)patients which PPPD group counted4and SWPD group13. Among the17DGE patients,8had grade A,6grade B and3grade C, most of whom complained of emesis and abdominaldistension. DGE is associated with abdominal operation history(P=0.023), POPF gradeB/C(P＜0.001), abdominal collection(P＜0.001), sepsis (P＜0.001) and wound problems(P=0.021). In the univariate analysis POPF grade B/C (P＜0.001), abdominal collection (P＜0.001), sepsis (P＜0.001) and wound problems (P=0.008) were associated with clinicalrelevant DGE. Multivariate analysis showed POPF grade B/C was the independent riskfactors for DGE.Conclusions:PPPD is a faster procedure with less blood loss and morbidity compared with SWPD.It’s proved PPPD with fine and careful surgical procedures were not the risk factor for DGE.POPF grade B/C was the independent risk factors for DGE.