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Therapeutic strategies for the management of delayed gastric emptying after pancreatic resection

  • Current Concepts in Clinical Surgery
  • Published:
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Abstract

Background

Delayed gastric emptying (DGE) is one of the most troublesome postoperative complications following pancreatic resection. Not only does it contribute considerably to prolonged hospitalization, but it is also associated with increased postoperative morbidity and mortality.

Methods

We performed an electronic and manual search of the international literature for studies dealing with the treatment of DGE following pancreatic resection using the Medline database. The search items used were “delayed gastric emptying,” “pancreaticoduodenectomy,” “Whipple procedure,” “pylorus-preserving pancreaticoduodenectomy,” and “complications following pancreatic resection” in various combinations.

Results

A number of studies were identified regarding possible therapeutic alternatives for the treatment of DGE. From the class of prokinetic regimens, most studies seem to support the use of erythromycin. However, its use has not gained wide acceptance. Regarding the operative technique, both standard Whipple and pylorus-preserving pancreatic resection carry similar rates of DGE. Billroth II type-like gastrointestinal reconstruction is the most widely accepted method and is associated with lower rates of DGE. Reoperations for managing severe DGE were very rarely reported.

Conclusions

The incidence of DGE in high-volume centers specialized in pancreatic surgery is well below 20%, thus following the improved rates that have been reported in the last decade regarding mortality and length of hospital stay after pancreatic surgery. DGE mandates a uniform definition and method of evaluation to achieve homogeneity among studies. Standardization of the operative technique, as well as “centralizing” pancreatic resections in high-volume centers, should aid to improve the occurrence of this bothersome postoperative complication.

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Authors and Affiliations

  1. 1st Department of Surgery, Agia Olga Hospital, 3-5 Agias Olgas Street, 14233, Nea Ionia, Greece

    Dimitrios Lytras, Costas Avgerinos, Costas Manes, Zisis Touloumis & Christos Dervenis

  2. 2nd Department of Surgery, Agia Olga Hospital, Athens, Greece

    Kosmas I. Paraskevas

  3. Department of Endoscopy, Agia Olga Hospital, Athens, Greece

    Konstantina D. Paraskeva

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  1. Dimitrios Lytras
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  2. Kosmas I. Paraskevas
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  3. Costas Avgerinos
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  4. Costas Manes
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  5. Zisis Touloumis
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  6. Konstantina D. Paraskeva
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  7. Christos Dervenis
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Correspondence to Christos Dervenis.

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Lytras, D., Paraskevas, K.I., Avgerinos, C. et al. Therapeutic strategies for the management of delayed gastric emptying after pancreatic resection. Langenbecks Arch Surg 392, 1–12 (2007). https://doi.org/10.1007/s00423-006-0096-7

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  • DOI: https://doi.org/10.1007/s00423-006-0096-7

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