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Should Gastric Decompression be a Routine Procedure in Patients Who Undergo Pylorus-Preserving Pancreatoduodenectomy?

Authors
 Joon Seong Park  ;  Jae Young Kim  ;  Jae Keun Kim  ;  Dong Sup Yoon 
Citation
 WORLD JOURNAL OF SURGERY, Vol.40(11) : 2766-2770, 2016 
Journal Title
WORLD JOURNAL OF SURGERY
ISSN
 0364-2313 
Issue Date
2016
MeSH
Adult ; Aged ; Aged, 80 and over ; Decompression, Surgical* ; Female ; Gastric Emptying ; Gastrostomy ; Humans ; Intubation, Gastrointestinal ; Male ; Middle Aged ; Organ Sparing Treatments ; Pancreaticoduodenectomy* ; Pylorus/surgery ; Reoperation ; Stomach/surgery* ; Unnecessary Procedures
Keywords
Pancreatic Fistula ; Nasogastric Tube ; Delay Gastric Emptying ; Tube Gastrostomy ; Bile Duct Cancer
Abstract
BACKGROUND: Nasogastric tube placement after abdominal surgery has been a standard procedure for many decades. In pancreatoduodenectomy, delayed gastric emptying (DGE) is still a leading postoperative complication, often resulting in patient anxiety or depression and prolonged hospital stays. Such complications have led many surgeons to prefer postoperative nasogastric decompression because of the greater risk of DGE. Therefore, the goal of this study was to evaluate the DGE and perioperative outcomes after pylorus-preserving pancreatoduodenectomy (PPPD) with or without routine gastrostomy. METHODS: From May 2009 to December 2014, 228 patients underwent PPPD at the Department of Surgery, Gangnam Severance Hospital, Yonsei University. The first cohort of 116 patients underwent surgery before June 2012 and uniformly underwent gastric decompression as a part of postoperative management. The second cohort of 112 patients underwent operation after July 2012, and gastric decompression was selectively used to facilitate exposure during operation and was removed in the operating room at the end of surgery. We evaluated DGE incidence, time to dietary tolerance, length of hospital stay, and postoperative gastric tube reinsertion rates. RESULTS: Gastric re-decompression was necessary in 38 patients (16.7 %), and there was a significant difference between the two groups (p = 0.006). Eleven (9.8 %) patients in the no-tube gastrostomy group required nasogastric tube reinsertion, and 27 (23.3 %) in the routine gastrostomy group required that the gastrostomy tube be re-drainage. There were no statistically significant differences in the frequency or severity of complications such as delayed gastric emptying or pancreatic leakage. CONCLUSIONS: Our study demonstrates that routine postoperative gastric decompression can be safely avoided in patients who undergo PPPD.
Full Text
https://link.springer.com/article/10.1007%2Fs00268-016-3604-0
DOI
10.1007/s00268-016-3604-0
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jae Keun(김재근)
Park, Joon Seong(박준성) ORCID logo https://orcid.org/0000-0001-8048-9990
Yoon, Dong Sup(윤동섭) ORCID logo https://orcid.org/0000-0001-6444-9606
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/152500
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