Effect of Right-to-Left (Isoperistaltic Anastomosis) or Left-to-Right (Antiperistaltic Anastomosis) Gastrojejunostomy Technique on the Delayed Gastric Emptying After the Whipple Surgery

How to Cite:Milad ArabiBehruz ShayestezadehAmin BahreiniEffect of Right-to-Left (Isoperistaltic Anastomosis) or Left-to-Right (Antiperistaltic Anastomosis) Gastrojejunostomy Technique on the Delayed Gastric Emptying After the Whipple Surgery.2(2):e148189.https://doi.org/10.32598/jjo.20.2.1.

Abstract

Objectives: Delayed Gastric Emptying (DGE) after the Whipple surgery is a common problem. This study aimed to compare the efficacy of Right to Left (R-to-L) (isoperistaltic anastomosis) gastrojejunostomy versus Left to Right (L-to-R) (antiperistaltic anastomosis) in DGE after the Whipple surgery.
Methods: In this clinical trial, 60 patients referred to Golestan and Arvand Hospital in Ahvaz City, Iran, who needed Pancreaticoduodenectomy (PD) or the Whipple procedure were recruited in our study and divided into two groups. The first group underwent gastrojejunostomy with isoperistaltic as R-to-L anastomosis and the second group antiperistaltic as L-to-R anastomosis. The two groups were compared one month after surgery for DGE severity, NPO (Nothing by mouth) duration, hospital stay duration, TPN (total parenteral nutrition) requirement, and rehospitalization requirement.
Results: DGE intensity in R-to-L decreased significantly compared to L-to-R (intensity: 5 [16.7%] vs 13 [43.5%]; P<0.001). In particular, the intensity difference was as follows: grade A=10%, grade B=6.7%, grade C=0%, versus grade A=20%, grade B=13.3%, grade C=10% (P<0.001). NPO duration and hospital stay in R-to-L were significantly lower than L-to-R (NPO: 3.1 vs 4.7, P=0.028; hospital stay: 4.3 vs. 7.8; P=003). The re-hospitalization rate in R-to-L was lower than in the other group (1 [3%] vs 8 [26.7%]; P<0.001). None of the R-to-L patients required TPN, but 16.7% of the L-to-R group required TPN, a significant difference (P<0.001).
Discussion: R-to-L gastrojejunostomy significantly reduces the delay in gastric emptying after the Whipple operation for a periampullary tumor.

Keywords

Gastrojejunostomy

Gastrointestinal motility

Gastric emptying

Gastroileal bypass

Pancreatic cancer

Pancreaticoduodenectomy

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Author(s):

Milad Arabi:[PubMed][Scholar]
Behruz Shayestezadeh:[PubMed][Scholar]
Amin Bahreini:[PubMed][Scholar]