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Ribeiro Skreinig, M.
Outcome of the analysis of patients undergoing a Whipple operation with preservation of the pylorus versus antrectomy: Does Diabetes mellitus influence the postoperative delayed gastric emptying?
Humanmedizin; [ Diplomarbeit ] Graz Medical University ; 2020. pp. 94 [OPEN ACCESS]


Authors Med Uni Graz:
Nagele-Moser Doris
Uranüs Selman

Introduction: One of the most common postoperative conditions after a Whipple operation is delayed gastric emptying (DGE). Symptoms include postprandial vomiting, abdominal discomfort, nausea, and protracted tolerance of solid foods. It usually leads to a longer hospital stay and has a negative impact on the patient’s postoperative quality of life. The choice of surgical method, having preoperative diabetes mellitus (DM), and other factors have often been observed in connection with DGE. The aim of this study was to not only see if there were differences between diabetics and non-diabetics regarding DGE occurrence, but also whether or not within this group, there were any differences due to the chosen variation of the Whipple operation (pancreatoduodenectomy with antrectomy = PD, or pylorus-preserving pancreatoduodenectomy = PPPD). Material and Methods: This study was performed retrospectively and monocentrically at the Department of Surgery of the University Hospital Graz. Data was collected from 161 patients who had undergone either PD or PPPD in the years 2008 through 2018, from their electronic medical records. The patients were split into two groups, depending on whether or not they had preoperative diabetes mellitus, and compared. Results: Multiple definitions of DGE were used for comparison in this analysis. ‘Genuine DGE’ was defined by applying exclusion and inclusion criteria to the recommended ISGPS definition of DGE. While not significant, there was a considerable difference in incidence among those who underwent PD (p=0,070), with 77,8% (n=7) of patients with preoperative DM, and 41,7% (n=20) of patients without DM being classified as having ‘genuine DGE’. For those who underwent PPPD, there was no significant difference between diabetics and non-diabetics (p=0,351). While those with preoperative DM showed a rate of 33,3% (n=7), those without DM had a rate of 44,6% (n=37). Conclusion: Due to the considerable difference in our cohort sizes, the results of this analysis must be viewed with caution. However, there seems to be a trend among diabetic patients to have a higher incidence of DGE after PD. Future prospective studies with more comparable cohort sizes would need to be performed before a recommendation for clinical practice could be determined.

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