Re: an antecolic Roux-en-Y type reconstruction decreased delayed gastric emptying after pylorus-preserving pancreatoduodenectomy by Murakami et al.

摘要

We read with great interest the article by Murakami et al.1 from the Department of Surgery, Hiroshima University, Japan in the June issue of the Journal of Gastrointestinal Surgery. The authors presented a retrospective series of 132 consecutive pylorus-preserving pancreatoduodenectomies performed at their institution between 1994 and 2006. All patients received a pancreatogastrostomy, but two different reconstruction methods to obtain the digestive continuity; either a retrocolic Billroth I type reconstruction (1994-2000) or an antecolic Roux-en-Y reconstruction (2001-2006). In a multivariate analysis, the reconstruction method was the only factor influencing the occurrence of delayed gastric emptying with a significant benefit for the antecolic reconstruction (81% versus 10%; P<0.03). To our knowledge, this is the first comparative study to clarify the beneficiary effect of an antecolic reconstruction method in patients with pancreatogastrostomy. A recent meta-analysis of three randomized controlled trials comparing pancreatojejunostomy with pancreatogastrostomy showed an overall comparable delayed gastric emptying (DGE) rate for both reconstruction techniques [15.8% versus 13.9%; OR 0.85 (0.50; 1.44), p=0.54]. However, the authors should clearly state why they have used an end-to-end reconstruction compared to the most commonly used method of an end-to-side gastrojejunostomy as described by Delcore et al.and why they have changed their operative strategy in 2001.