Varianten der retrokolischen Rekonstruktion nach partieller Pankreatoduodenektomie und deren Einfluss auf die Magenentleerung – infra- oder suprakolisch

Zusammenfassung

Hintergrund Die Magenentleerungsstörung (MES) ist die häufigste Komplikation nach partieller Pankreatoduodenektomie. Während eine ante- oder retrokolische Lage keinen Einfluss auf die Häufigkeit einer MES hat, wurde wiederholt postuliert, dass eine infrakolische im Gegensatz zur suprakolischen Duodenoenterostomie durch die gestreckte Position des Magenausgangs vorteilhaft ist. Beide Formen der retrokolischen Rekonstruktion wurden bislang nicht miteinander verglichen.

Patienten 138 Patienten wurden zwischen 2011 und 2017 an unserer Klinik einer pyloruserhaltenden Pankreatoduodenektomie mit retrokolischer 1-Schlingen-Rekonstruktion unterzogen. Hiervon wurden 105 supra- und 33 infrakolisch rekonstruiert und bez. demografischer Faktoren, Diagnose, Vorerkrankungen, intraoperativer Charakteristika, Krankenhausverweildauer, Morbidität und Mortalität und der Entwicklung einer MES miteinander verglichen. Alle Komplikationen wurden gemäß der ISGPS-Klassifikationen (ISGPS: International Study Group of Pancreatic Surgery) dokumentiert.

Ergebnisse Beide Gruppen waren bez. Grund- und Vorerkrankungen, perioperativem Verlauf und Komplikationsspektrum miteinander vergleichbar. Eine MES trat in beiden Gruppen gleich häufig auf (MES Grad A/B/C suprakolisch 25/14/10 und infrakolisch 12/5/2, p = 0,274). Tritt eine MES auf, so sind Intensivstationsaufenthalt (p = 0,007) und Krankenhausaufenthalt (p = 0,001) signifikant verlängert. Die Risikofaktoranalyse zeigte eine Häufung von MES bei vorbestehendem Diabetes mellitus (p = 0,047) und Majorkomplikationen (Clavien Grad III – V, p = 0,048), wohingegen der Einsatz von Somatostatinanaloga protektiv wirkte (p = 0,021).

Schlussfolgerung Die supra- oder infrakolische Position der Duodenoenterostomie hat keinen Einfluss auf die Entwicklung einer MES nach Pankreatoduodenektomie. Tritt eine MES auf, so ist der stationäre Aufenthalt signifikant verlängert. Eine mögliche Vermeidungsstrategie könnte in der Gabe von Somatostatinanaloga bestehen.

Abstract

Background Delayed gastric emptying (DGE) is the most frequent complication following pancreatoduodenectomy. While antecolic and retrocolic reconstruction does not influence the occurrence of DGE, infracolic reconstruction might alleviate DGE due to the vertical position of the distal stomach compared to supracolic reconstruction. Supra- and infracolic reconstruction have not yet been compared.

Patients 138 patients underwent pylorus-preserving pancreatoduodenectomy with retrocolic reconstruction at our department between 2011 and 2017. Of these, 105 were reconstructed with supracolic duodenoenterostomy and 33 with infracolic duodenoenterostomy. Patients were analysed with respect to demographic factors, diagnosis, pre-existing conditions, intraoperative characteristics, hospital stay and morbidity and mortality with special emphasis on DGE. All complications were classified according to the definitions of the International Study Group on Pancreatic Surgery.

Results The two groups were comparable with respect to diagnosis, medical history, intraoperative characteristics, morbidity and mortality. DGE was equally distributed between supra- and infracolic reconstruction (DGE stage A/B/C25/14/10 vs. 12/5/2, p = 0.274). With DGE, intensive care unit stay (p = 0.007) and hospital stay (p = 0.001) are significantly delayed. Risk factor analysis showed that pre-existing diabetes (p = 0.047) and major complications (Clavien stage III – V, p = 0.048) are risk factors for DGE, while the use of somatostain-analogues seems to have a protective effect (p = 0.021).

Conclusion Supra- or infracolic reconstruction does not influence the frequency of DGE following pancreatoduodenectomy. When DGE occurs, hospital stay is delayed. Somatostatin analogues may act prophylactically on DGE.

Schlüsselwörter

Whipple-Operation - Pankreaskopfresektion - Magenentleerungsstörung - retrokolische Rekonstruktion - Pankreatoduodenektomie

Key words

Whippleʼs procedure - pancreatic head resection - delayed gastric emptying - retrocolic reconstruction - pancreatoduodenectomy

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