RESUMO
Delayed gastric emptying is one of the leading causes of morbidity following pancreatico-dudenectomy occurring in nearly one third of patients. Literature reports indicate that the incidence of delayed gastric emptying [DGE] is higher after Pylorus-preserving pancreaticodudenectomy [PPPD] than after conventional pancreatico-dudenectomy [CPD]. Delayed Gastric emptying is traditionally diagnosed from patient report subjective sensations. In order to improve gastric emptying, distal subtotal gastrectomy with resection of nearly 60% of the stomach converting it from a reservoir into a conduit is undertaken to prevent gastric stasis and shortens transient time. Over a period of five years from 2001-2006, a total of twenty patients with operable pancreatic lesions underwent extended gastric resection in the form of distal subtotal gastric resection concomitant with pancreaticodudenectomy. The male-female ratio was 14/6, the mean age was 55 years with 15.5 standard deviation [SD]. This group was compared prospectively with a matched control group of patients who underwent conventional pancreaticodudenectomy regarding the development of delayed gastric emptying. We sought to quantify the rates of subjective DGE [sDGE] based on patient complaint versus objective DGE [oDGE] based on gastrograffin study in the tenth post operative day post Extended distal subtotal gasric resection with pancreatico-dudenectomy group [EPD] and the control retrospective group post conventional pancreatico-dudenectomy [CPD]. For the 20 patients in the EPD group and the other 20 patients in the CPD control group sDGE and oDGE data were collected on the postoperative day 14, and 6 months postoperatively. The incidence of sDGE was higher for the CPD [42%] than for EPD [15%] at 14 days, [33%] and [6%] at 6 months. The oDGE was higher for CPD [9 1%] than for EPD [67%] at 14 days, with a 6-months incidence of [37%] in CPD and [4.7%] for EPD. The proximal gastric function detected by the Liquid phase gastric emptying test [normal control reference=23 minutes] was prolonged for the CPD group [73 minutes] compared to [38 minutes] for the ECP in the first 14 days. At 6-months interval the LGE was [48 minutes] for CPD and [12.7 minutes] for ECP. 1-The concept of DGE should distinguish between subjective and objective symptoms. 2-The loss of distal stomach mechanoreceptors in EPD reduces patient sensation of oDGE producing silent DGE. 3- The EPD contributed greatly in preventing the early delayed gastric emptying, resulting in short hospital stay and decrease cost with minimal associated surgical morbidity