Impact of Gastrojejunostomy Configuration on Delayed Gastric Emptying Following Pancreaticoduodenectomy: A...

Delayed gastric emptying (DGE) is a significant complication following pancreaticoduodenectomy, affecting 20-40% of patients and impacting hospital stay, healthcare costs, and adjuvant therapy initiation. Different gastrojejunostomy configurations have been investigated to reduce DGE rates, with conflicting results presented in the literature. This retrospective study analyzed 65 consecutive patients who underwent pylorus-preserving pancreaticoduodenectomy at Bnai-Zion Medical Center between August 2018 and December 2023. All procedures were performed by a single experienced surgeon using either antecolic (AC, n = 25) or transmesocolic (TMC, n = 40) reconstruction. DGE was classified according to International Study Group of Pancreatic Surgery criteria. The statistical analysis included logistic regression to identify risk factors. The overall DGE incidence was 23.1% (15/65 patients). The AC group demonstrated significantly higher DGE rates compared to the TMC group (40% vs. 12.5%, p = 0.01). Logistic regression analysis revealed a 5.91-fold increased risk of DGE with AC reconstruction (OR: 5.91; 95% CI: [1.44, 24.25]; p = 0.014). All severe DGE cases (grades B and C) occurred exclusively in the AC group. Hospital stay was significantly longer in DGE patients (median: 26 vs. 13 days, p < 0.001). Other variables, including age, gender, smoking, diabetes, BMI, and surgical approach, showed no significant association with DGE. In this single-surgeon study, antecolic reconstruction was associated with significantly higher rates and severities of delayed gastric emptying compared to transmesocolic reconstruction. These findings suggest that reconstruction technique represents a modifiable risk factor for DGE prevention, though larger prospective studies are needed to confirm these results.