Risk factors for delayed gastric emptying after pancreaticoduodenectomy

Abstract

Introduction: Delayed Gastric Emptying (DGE) is one of the most common postoperative complications after pancreatic surgery, occurring in 19%-57% of patients. Although DGE is known to be associated with other intra-abdominal complications, factors responsible for DGE in patients without intra-abdominal complications are poorly understood. Aim: The aim of the present study is to analyze factors causing Delayed Gastric Emptying after pancreaticoduodenectomy.Materials and Methods: This was a prospective study done in the Department of Surgical Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad between Feb 2007 and Jun 2009. All patients who underwent elective pancreaticoduodenectomy were included in this study. The risk factors assessed were patient factors, disease factors, operative factors and postoperative factors. The risk factors for DGE, Grade B & C DGE and DGE without intrabdominal complication were assessed.Results: Delayed Gastric emptying occurred in 29 patients (45.3%) according to ISGPS criteria (Grade A 14; Grade B 8; Grade C 7). DGE without intrabdominal complication was seen in 12 patients (18.7%). The significant factors independently predicting DGE were Intraabdominal complication (OR 6.5, CI 1.424 -14.95, p = .011) and Diabetes (OR 3.5, CI .926 - 27.04, p = .06). Independent factor for Grade B & C DGE was Intraabdominal complication (OR 4.76, CI 1.15 - 19.63, p = 0.03). Factors independently predicting DGE without intraabdominal complication was retrocolic duodenojejunostomy (OR 3.99, CI 1.037 - 42.664, p = 0.04).Conclusions: Intraabdominal complications and diabetes were independent risk factors for DGE. Retrocolic duodenojejunostomy was an independent risk factor for DGE without intraabdominal complication.