Delayed Gastric Emptying After Laparoscopic Versus Open Pancreaticoduodenectomy:a Comparative Study

Yongbin Li, MD, Xin Wang, MD, Shuangchen Ke, MD, Mingjun Wang, MD, Zhengguo Yang, MD, Bing Peng, MD, PhD

Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University

Introduction:Delayed gastric emptying (DGE) is a frequent postoperative complication after pancreaticoduodenectomy(PD). At present, little data is available for comparing the effect on DGE of laparoscopic versus conventional open PD treatment. Therefore, the purpose of this study was to investigate whether the use of laparoscopic pancreaticoduodenectomy(LPD) versus open pancreaticoduodenectomy (OPD) effects the postoperative incidence of DGE.

Methods: Data from 61 consecutive PD procedures performed between October 2010 and August 2012 were retrospectively reviewed. Among them, 18 patients underwent LPD, and 43 patients underwent OPD. These two groups were compared with each other. The primary end point was to compare the two groups in terms of postoperative DGE, including DGE rate and grading (DGE as defined by International Study Group of Pancreatic Surgery). Secondary outcomes were other complications and hospital stay. Continuous variables were compared by the Student’s t test and ANOVA, and categorical variables were compared using chi-square test, Fisher’s exact test or Mann-Whitney U test. Multivariate logistic regression model was used to identify the risk factors of DGE.

Results: Differences in the demographics of the two groups were statistically insignificant. The laparoscopic group had significantly longer operative times (503.9 min vs 380.1 min ,p:0.000), reduced blood loss (285 ml vs 404.7 ml ;P:0.000) and shorter postoperative hospital stays (13.6 days vs 16.1 days P:0.009) than the open group. However, there was no difference in terms of DGE rate (27.8% vs 27.9%, P:0.92) and postoperative complication rates (55.6% vs 51.6%, P:0.745). Furthermore no difference in DGE grading were found. There was one postoperative death in the OPD group and none in the LPD group. Multivariate analysis by logistic regression model showed that DGE was significantly more frequent among patients with longer operative times (OR:1.02; 95% CI,1.002-1.042, p: 0.03),increased intraoperative blood loss(OR:1.006;95% CI,1.00-1.012, p: 0.035)and postoperative intraabdominal complications (OR:5.97;95% CI,1.24-28.8; p:0.026). Use of LPD was not associated with occurrence of DGE. Mean postoperative hospital stay was longer among patients who developed DGE(19.7 days vs 13.8days p:0.000) than those without DGE .

Conclusions: This study shows that the incidence of DGE does not appear to be effected by operative approach (laparoscopic vs open). Longer operative time, increased intraoperative blood loss and postoperative intraabdominal complications appear to be risk factors for DGE development. The laparoscopic approach to pancreaticoduodenectomy is safe and feasible, and outcomes appears comparable with those undergoing an open approach.

Session: Poster Presentation

Program Number: P328

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