Enteral nutrition prolongs delayed gastric emptying in patients after whipple resection

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Abstract

Background: Delayed gastric emptying is one of the most frequent postoperative complications after Whipple resection. In the present study we evaluated the role of enteral nutrition in the development of delayed gastric emptying after Whipple resection.

Patients and methods: Between January 1996 and June 1998, 64 patients (30 female, 34 male) underwent a classic (n = 27) or pylorus-preserving (n = 37) Whipple resection. Two patients were excluded; 30 patients received enteral and 32 patients received no-enteral nutrition.

Results: Delayed gastric emptying occurred significantly more in patients with enteral (17 of 30, 57%) than in patients with no-enteral nutrition (5 of 32, 16%) (P <0.01). Consequently, patients in the enteral nutrition group had a nasogastric tube for a significantly (P <0.01) longer period and had a significantly (P <0.01) longer hospital stay than patients in the no-enteral nutrition group. There were no differences in the frequency of occurrence of other postoperative complications between patients with enteral and no-enteral nutrition.

Conclusion: In patients undergoing a Whipple resection, enteral nutrition is associated with a higher frequency of delayed gastric emptying with no advantages regarding other postoperative complications and should therefore be restricted to specific indications.

Section snippets

Patients and methods

All patients who had undergone either a classic Whipple resection or a pylorus-preserving Whipple resection between January 1, 1996, and June 30, 1998, were included. In this period, 64 patients (30 female, 34 male; mean age ± SD: 63.2 ± 13 years, range 16 to 81) underwent a Whipple operation. The clinical data were registered in a prospective computerized data base using a standardized prospective documentation form that is used for the documentation of all patients with pancreatic diseases.

Results

In the 64 patients who underwent a Whipple resection between January 1, 1996, and June 30, 1998, hospital mortality was 3.1% (2 of 64). One patient died on the 11th postoperative day with acquired respiratory distress syndrome (ARDS) and sepsis, and another patient died on the 90th postoperative day owing to recurrent intestinal bleeding from an aneurysm of the common hepatic artery. Twenty-three patients developed postoperative complications (36%). In total, 26 postoperative complications (13

Comments

Physiological gastric emptying and motility of the digestive system are controlled and regulated by diverse feedback mechanisms. On the one hand, various hormones such as cholecystokinin, gastrin, secretion, motilin, and somatostatin affect the contractions of the proximal and distal stomach and the duodenum.22, 23, 24 On the other hand, tonic contractions of the proximal stomach are of importance for the transfer of liquid food from the stomach to the duodenum.25, 26, 27, 28 Peristaltic

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