A Retrograde Tube-Gastrostomy Technique for Management of Delayed Gastric Emptying after Pylorus-Preserving Pancreatoduodenectomy

Delayed gastric emptying (DGE) is one of the most frequent and unpleasant postoperative discomforts in patients who were given pylorus-preserving pancreatoduodenectomy (PPPD). To prevent DGE after PPPD with the modified version of Traverso\u27s reconstruction procedure, we have used retrograde tube-gastrostomy technique. In our method, a 16-Fr gastrostomy tube with several pores was inserted in the retrograde direction from the jejunal stump into the gastric fundus, by leading the catheter tip through the jejuno-jejunal anastomosis, the efferent jejunum and the pylorus. Between January 1996 and September 2003, 51 patients underwent PPPD for periampullary malignancy in our department. DGE after PPPD was observed in 12 patients (23.5%); 2 of the 19 patients (10.5%) with retrograde tube-gastrostomy technique and 10 of the 32 patients (31.3%) with conventional tube-gastrostomies. Because of effective internal drainage of gastric juice to the efferent jejunum by this method, the external gastric drainage from the gastrostomy tube was extremely small when compared to conventional tube-gastrostomies, resulting in reduction of postoperative venous infusion and hypochloremia. Oral intake was also started earlier after surgery, and the postoperative hospital stay was shortened. In conclusion, the retrograde tube-gastrostomy technique was found easy to perform and beneficial to the patients undergoing PPPD