The Effect Of Different Gastrointestinal Anastomosis On Delayed Gastric Emptying After Pancreaticoduodenectomy

Background and purpose: In recent years,the incidence of malignant tumors has increased significantly in the world.Surgical treatment plays a most important role in the treatment of malignant tumors,but postoperative complications also have a great impact on the quality of life of patients.Pancreaticoduodenectomy is one of the largest digestive system operations.Because of the complicated operation,many organs are involved,and the incidence of postoperative complications is high.Delayed gastric emptying is one of the common complications after pancreaticoduodenectomy.The etiology and pathogenesis of gastric emptying has not been identified worldwide.It is still a difficult problem for clinicians and patients.Our center has improved the method of Billroth II gastrointestinal anastomosis in pancreatoduodenectomy since January 2016,Stapler instead of Anastomat.Now we compare the effect of two methods on delayed gastric emptying after pancreaticoduodenectomy.Methods: A retrospective analysis was made of the cases of pancreaticoduodenectomy from January 2014 to December 2017 in the Department of hepatobiliary and pancreatectomy,the First Hospital of Jilin University.(1)The effects of different anastomosis methods on the incidence of gastric emptying,the incidence of long-term complications,gastric tube extraction time and postoperative hospitalization time were studied by a Case-Control Study;(2)the Logistic Regression Analysis was used to study the effect of different anastomosis methods on delayed gastric emptying under the combined effects of many risk factors.Results: According to the inclusion criteria,178 cases were included,of which 77 cases of Anastomat gastrointestinal anastomosis,101 cases of Stapler gastrointestinal anastomosis,and the incidence of delayed gastric emptying was about 13.48%(24/178).(1)Anastomat groups(53 cases)and Stapler groups(67cases)were established in the Case-Control Study to exclude other risk factors for gastric emptying.The incidence of delayed gastric emptying in Stapler group was lower than that in Anastomat group(p<0.01).The incidence of long-term complications was not statistically significant between the two groups(p > 0.05).The cases of gastric emptying were further excluded,establishing Anastomat group A and Stapler group A,Stapler group A gastric tube extraction time and postoperative hospitalization time were smaller than Anastomat group A(p<0.01/p<0.05).(2)In the study of Logistic Regression Analysis,the DGE group (24cases) and the non DGE group(154 cases)were established.Two groups of age,sex,method of gastrointestinal anastomosis,pancreatic fistula,bile fistula,postoperative bleeding,infection,operative time,intraoperative bleeding,history of operation,combined organ resection and vascular reconstruction were examined by single factor chi-square test.The results showed that the method of gastrointestinal anastomosis,pancreatic fistula and postoperative bleeding were the risk factors of delayed gastric emptying.The possible variables were introduced into multivariate Logistic Regression analysis,and the pancreatic fistula was the risk factor of delayed gastric emptying after pancreaticoduodenectomy(p <0.05),and the Stapler gastrointestinal anastomosis protective factor of delayed gastric emptying(p<0.05).Conclusion: The use of stapler device Billrosh II gastrointestinal anastomosis can reduce the incidence of postoperative gastric emptying after surgery,shorten the gastric tube extraction time and postoperative hospitalization time,and is an protective factor for gastric emptying.