The Comparative Study Of Gastric Resection Way In Laparoscopic Pancreaticoduodenectomy

Objective: To investigate the clinical features and feasibility of delayed gastric emptying after about one-half of disconnected stomach versus about one third of disconnected stomach and pylorus-preserving laparoscopic pancreaticoduodenectomy.Methods:Clinical data of 202 consecutive patients who underwent laparoscopic pancreaticoduodenectomy from September 2016 to November 2018 in the Second Hospital of Hebei Medical University were retrospectively analyzed and collected.120 patients underwent about one-half of disconnected stomach laparoscopic pancreaticoduodenectomy(1/2 disconnected stomach group)and 82 patients underwent traditional(about one third of disconnected stomach and pylorus-preserving)laparoscopic Whipple procedure(control group)among them.To compare the effect on delayed gastric emptying(DGE)and perioperative main complications between about one-half of disconnected stomach LPD and traditional(about one third of disconnected stomach and pylorus-preserving)LPD.The informed consents of all patients were obtained and the local ethical committee approval was received.The results were analyzed by SPSS20.0 statistics software.Result:There were no significant differences in basic clinical information between the two groups.20 patients have delayed gastric emptying in traditional(about one third of disconnected stomach and pylorus-preserving)LPD group,the overall incidence of delayed gastric emptying(DGE)was 24.39%(20/82),the incidence of grade A,grade B and grade C DGE was 8.54%(7/82),9.76%(8/82)and 6.10%(5/82)respectively.16 patients occured with DGE in about one-half of disconnected stomach LPD group,the overall incidence of delayed gastric emptying(DGE)was 13.33%(16/120),the incidence of grade A,grade B and grade C DGE was 6.67%(8/120),3.33%(4/120)and 3.33%(4/120)respectively.Compared with traditional(about one third of disconnected stomach and pylorus-preserving)laparoscopic pancreaticoduodenectomy,the incidence of delayed gastric emptying(DGE)after about one-half of disconnected stomach laparoscopic pancreaticoduodenectomy was 13.33%(16/120),significantly lower than that(24.39%,P<0.05)of delayed gastric emptying(DGE)after traditional(about one third of disconnected stomach and pylorus-preserving)LPD,especially the incidence of clinically relevant delayed gastric emptying(grade B and grade C).Other major postoperative complications were not obviously different(P≥0.05).Conclusion:In LPD,about one-half of disconnected stomach laparoscopic pancreaticoduodenectomy obviously decreases the risk of clinically relevant delayed gastric emptying.Compared with traditional(about one third of disconnected stomach and pylorus-preserving)LPD,it is safe and feasible to disconnect stomach by the way of about one-half,and worth further research.To provide reference and new ideas for clinical surgeon of laparoscopic pancreaticoduodenectomy.