• Adeel S Khan, Greg Williams, Cheryl Woolsey, Jingxia Liu, Ryan C Fields, Majella M B Doyle, William G Hawkins, and Steven M Strasberg.
• Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO.
• J. Am. Coll. Surg. 2017 Oct 1; 225 (4): 498-507.

BackgroundDelayed gastric emptying (DGE) is a common serious problem after pancreaticoduodenectomy (PD). Flange gastrojejunostomy (FL-GE) is a previously described technique that creates an internal flange in a hand-sewn gastroenterostomy. Results of FL-GE on incidence and severity of DGE after PD are presented.Study DesignData were extracted from a prospective database of PD. Standard PD with antrectomy were performed with flange gastroenterostomy (FL-GE) or other techniques (NonFL-GE) at a single institution. The International Study Group of Pancreatic Surgery (ISGPS) definition of DGE was used, and DGE severity was graded based on the ISGPS grading system and the Modified Accordion Grading System (MAGS).ResultsThere were 215 standard PDs performed. Sixty-eight (32%) were FL-GE and 147 (68%) were NonFL-GE. Delayed gastric emptying rates in FL-GE and NonFL-GE were 9% and 23%, respectively (p = 0.012). Differences in severity of DGE were even more prominent: 29% of DGEs in the NonFL-GE group were ISGPS grade C vs 0% in FL-GE. Also, 35% of DGEs in the NonFL-GE group were MAGS 3 vs 0% in FL-GE. Because of some differences in sex and inflammatory complications between groups, a propensity score analysis was performed, creating 57 matched patients in the FL-GE and NonFL-GE groups. The incidence of DGE remained significantly different in the groups (5% in FL-GE vs 18% in NonFL-GE; p = 0.039).ConclusionsIn this cohort study, the flange technique was associated with a marked reduction in the incidence of DGE after PD.Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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