Title : Delayed gastric emptying after pylorus preserving pancreaticoduodenectomy, outcome and management single center study
Abstract:
Introduction: Pancreatic cancer currently the fourth leading cause of deaths and has one of the lowest 5-year related survival rates among all cancer sites 8% at all stages (Diener et al., 2017). Complete tumor resection is the only potentially curative option, so pancreaticoduodenectomy is the treatment of choice for various benign and malignant tumor of pancreatic head or periampullary region (Lee et al.,2021). Delayed gastric emptying is one of the most common complications after pylorus preserving pancreaticoduodenectomy lead to patient discomfort prolonged hospitalization and increased hospital coast it is complex phenomena with multifactorial genesis and associated with other major intra abdominal complication as pancreatic fistula and infected collection (Keck et al.,2016).
Aim of this Study: Assess the incidence and management of delayed gastric emptying following PPPD in management of periampullary cancer in NLI, Menofia University.
Patients and Methods: 20 cases of pancreatic head cancer or periampullary put under inclusion criteria, managed by PPPD, suffering from delayed gastric empting. Patients divided into two groups group A (DGE) other group B (non DGE) both groups studied as regard preoperative factors as age sex associated morbidity as (HTN, DM, cardiac renal insufficiency, viral hepatitis). Intraoperative factors as operative time blood loss and transfusion. Post operative course evaluated as drugs timing of (NGT) removal, incidence of vomiting and frequency, post operative complications, ICU stay, hospital stay and laboratory values upon discharge.
Results: Patients with (DGE) stay long time in ICU range from 3-13 days while other group (NON DGE) stay 2-6 days with increased significant, also time of hospital stay in group (DGE) 8-15 days prolonged than (NON DGE) from 5-8 days all patients put under taking medical treatment as Nexium Gast-reg, metronidazole, levoxine, cefepime, meronam, clexan, primperan, and domperidone.
Conclusion: After PPPD, DGE common but not serious complication facing patients to prolonged ICU and hospital stay with exposure to nosocomial infection especially in COVID-19 era, it also impairs post operative nutrition which is the corner stone in recovering after cancer surgeries.
Recommendation: Future research should focus on large number, register based prospective randomized controlled trials.
