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. 2021 Jun;12(2):378-385.
doi: 10.1007/s13193-021-01298-5. Epub 2021 Apr 7.

Is Roux Loop a Solution to Delayed Gastric Emptying Following Pancreaticoduodenectomy? A Single Institute Analysis

B R Keerthi  1 , G N Hemanth  1 , M S Ganesh  1 , Amritha Prabha  1 , I Abhinay  1
Affiliations

Is Roux Loop a Solution to Delayed Gastric Emptying Following Pancreaticoduodenectomy? A Single Institute Analysis

B R Keerthi et al. Indian J Surg Oncol. 2021 Jun.

Abstract

Delayed gastric emptying is one of the most common complications of pancreaticoduodenectomy (PD). It almost always results in delayed oral intake, prolonged hospital stays, and a delay in initiation of vital adjuvant treatment. A few earlier studies suggested that delayed gastric emptying (DGE) rates were better with the Roux-en Y reconstruction, but Indian literature regarding this is lacking. In our institutional study, we compared the traditional single-loop reconstruction (SL group), with the Roux loop reconstruction (RY group) following a subtotal stomach-preserving pancreaticoduodenectomy (SSPPD). A retrospective comparative study was conducted between the conventional single loop and a Roux-en-Y method of reconstruction following a subtotal stomach preserving pancreaticoduodenectomy (SSPPD). Sixty-three consecutive Whipple's procedures were analyzed for multiple clinical parameters like removal of Ryles tube, tolerance of liquid diet and solid diet, delayed gastric emptying, duration of hospital stay and interval between surgery, and initiation of adjuvant treatment. Forty-one patients in the SL group were compared with 22 patients in the RY group. Ryles tube removal (POD 8.2 versus 2.25, p < 0.001), initiation of liquid diet (POD 8.43 versus 2.88, p < 0.001), post-operative hospital stay (13.5 days versus 9.63, p < 0.001), and interval between surgery and adjuvant treatment (37.75 days versus 28.88 days, p < 0.002) were all in favor of the RY group. The delayed gastric emptying was also found to be significantly better in the Roux-en-Y surgery group (p < 0.001). The Roux loop reconstruction following a stomach-preserving pancreaticoduodenectomy (SSPPD) is superior to single-loop reconstruction with respect to delayed gastric emptying. The lesser duration of hospital stay and early initiation of adjuvant therapy are an additional benefit of the Roux loop reconstruction.

Keywords: Delayed gastric emptying (DGE); Pancreaticoduodenectomy; Roux-en-Y.

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Figures

Fig. 1
Fig. 1
Diagrammatic representation of the traditional single-loop technique (SL) on the left, and the Roux-en-Y technique (RY) on the right
Fig. 2
Fig. 2
The point of transection of the jejunum exactly 15 cm after the HJ
Fig. 3
Fig. 3
Jejunojejunostomy (JJ) 45 cm from gastrojejunostomy (GJ)
Fig. 4
Fig. 4
Distribution of cases in each group
See this image and copyright information in PMC

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