Pancreatic fibrosis correlates with delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy with pancreaticogastrostomy

Ann Surg. 2002 Feb;235(2):240-5. doi: 10.1097/00000658-200202000-00012.


Objective: To show that residual pancreatitis delays gastric emptying, the authors used surgical specimens and studied gastric stasis after pylorus-preserving pancreaticoduodenectomy (PPPD).

Summary background data: Delayed gastric emptying is a leading cause of complications after PPPD, occurring in 30% of patients. The pathogenesis of delayed gastric emptying remains unclear.

Methods: Surgical specimens of the pancreas from 25 patients undergoing PPPD and pancreaticogastrostomy were collected and examined by microscopy according to progressive pancreatic fibrosis and divided into three groups: no fibrosis, periductal fibrosis, and intralobular fibrosis. The authors then measured gastric output from the nasogastric tube, pancreatic output from the pancreatic tube, and the time until patients tolerated a solid diet.

Results: Pancreatic juice output was significantly related to the degree of pathologic findings, and gastric output was inversely related to them. A significant prolongation of postoperative solid diet tolerance correlated with increased pancreatic fibrosis and gastric fluid production.

Conclusions: Pancreatic fibrosis and increased gastric fluid production correlate with delayed gastric emptying after PPPD with pancreaticogastrostomy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Fibrosis
  • Gastric Emptying*
  • Gastric Juice / metabolism
  • Gastrostomy / methods
  • Humans
  • Male
  • Middle Aged
  • Pancreas / pathology*
  • Pancreatic Neoplasms / surgery*
  • Pancreaticoduodenectomy* / methods
  • Postoperative Period
  • Time Factors