Completed Resection Of Gastric Antrum Is Associated With Decreased Incidence And Severity Of Delayed Gastric Emptying After Pancreaticoduodenectomy

ObjectiveDelayed gastric emptying?DGE?is one of the main complications after pancreaticoduodenectomy?PD?.We hypothesized that complete resection of the gastric antrum is associated with decreased incidence and severity of DGE after PD.MethodDistal gastrectomy was performed in Sprague–Dawley?S-D?rats?expanded resection of the gastric antrum,ER group;complete resection of gastric antrum,CR group;incomplete resection of gastric antrum,IR group?and the tension?g?of remnant stomach contraction was observed.A total of 174 patients were divided into IR group?89 patients?and CR group?85 patients?,and the incidence of DGE was explored after PD.Histological morphology of smooth muscle in control gastric specimens was observed.ResultsIn rats,the ex vivo remnant stomachs of CR group exhibited much greater contraction tension than those of the other two groups?P<0.05?.The contraction tension of the remnant stomach was dependent on Ach concentration but remained stable at a concentration of 1.0×10^-4 mol/L.In patients,the incidence of DGE was significantly lower in CR group than in IR group?P<0.01?.Postoperative hospital stay was significantly shorter in CR group than that in IR group?P<0.05?.In addition,haematoxylin-eosin staining?HE?analyses confirmed that the transected circular smooth muscle bundles were much more numerous in IR group than those in CR group?P<0.05?.ConclusionsThis study provides compelling in vivo and ex vivo evidence indicating that the complete resection of the gastric antrum is associated with decreased incidence and severity of DGE after PD.Gastric electrophysiological and physiopathological disorders caused by damage to gastric smooth muscles and vagal innervation might be the mechanism underlying DGE.