Impact of the gastrojejunal anatomic position as the mechanism of delayed gastric emptying after pancreatoduodenectomy.

BACKGROUND: This study investigated the impact of gastrojejunal anatomic position on the incidence of delayed gastric emptying after pancreatoduodenectomy. METHODS: A total of 160 patients were included in the retrospective analysis. The relative anatomic position of the gastrojejunostomy was evaluated using coronal and sagittal plane computed tomography images on postoperative day 7; the coronal cardia anastomotic angle and the sagittal fundus anastomotic angle were measured. In the validation study, 64 consecutive patients were enrolled, and gastric emptying was evaluated using water-soluble contrast medium. The extent of gastric emptying was graded as grade I (no gastric dilatation and no stasis), grade II (gastric dilatation but no stasis), or grade III (gastric dilatation and stasis). RESULTS: Patients with grades B (n = 8) and C (n = 22) delayed gastric emptying were included in the delayed gastric emptying group (n = 30), and the others were included in the nondelayed gastric emptying group (n = 130). The coronal cardia anastomotic angle was not significantly different between the 2 groups, whereas the sagittal fundus anastomotic angle was significantly greater in the delayed gastric emptying group compared to the nondelayed gastric emptying group (median 50.3 vs 64.5 degrees, P < .001). Multivariate analysis, including various risk factors of delayed gastric emptying, indicated that a sagittal fundus anastomotic angle >60 degrees was the only independent risk factor of delayed gastric emptying (odds ratio, 16.59). In the validation study, the median degree of sagittal fundus anastomotic angle increased as the gastric emptying grade increased (grade I, 44.3 degrees; grade II, 55.3 degrees; grade III, 60.7 degrees; P = .014 by analysis of variance). CONCLUSION: The gastrojejunal anatomic position after pancreatoduodenectomy has a significant impact on the incidence of delayed gastric emptying. (Surgery 2017;160:XXX-XXX.).