Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of General Surgery

Delayed gastric emptying (DGE) occurs in 14~59% of patients after pancreaticoduodenectomy (PD). Some meta-analysis studies revealed that there is no significant difference in the incidence of DGE after pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ). While other studies found a higher significant incidence of DGE in the PG group. The pathogenesis of DGE have been widely debated. Purpose: Evaluation of gastric emptying (GE) in post-pancreaticoduodenectomy patients to compare the effect of PG versus PJ on GE. Methods: Between April 2016 and September 2019, 30 patients who underwent PD were investigated for the effect on GE. The patients were divided into two groups (PG vs PJ) each group with 15 patients. Gastric Emptying Scintigraphy (GES) was done for the evaluation of GE pre and post-operative.The operative time, blood loss, the specimens' pathology and resection margins, the interpretation of GES study and finally the hospital course data were all gathered and subjected to statistical analysis. Results: DGE was obvious in all cases with PG while it was encountered only in 4 patients of 15 with PJ. Seven cases developed post-operative pancreatic fistula (POPF),3 after PG versus 4 after PJ, and were all successfully managed conservatively.Conclusion: DGE is significantly more in PG rather than PJ. The mechanical effect of the PG anastomosis could be one reason.The associated post-operative complications such as POPF are factors associated with DGE

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