Delayed Gastric Emptying after Gastropancreatoduodenal Resection: Our Experience

Introduction. Gastro-pancreaticoduodenal resection remains the only radical treatment of biliopancreatic and duodenal malignancies. However, this procedure is associated with a high likelihood of postoperative complications. Among them, delayed gastric emptying (DGE) is the most common, although its etiology is still unclear. While DGE is not a life-threatening condition, it significantly prolongs hospitalization, increases treatment costs, and delays the initiation of adjuvant chemotherapy. The aim of this study was to evaluate the effectiveness of treatment modalities and summarize the clinical experience of managing patients with DGE. Materials and methods . The study was conducted at the I.K. Akhunbaev Clinic of the National Hospital of the Ministry of Health of the Kyrgyz Republic, Bishkek. Between 2009 and 2023, 85 gastro-pancreaticoduodenal resections were performed for biliopancreatic and duodenal malignant neoplasms. The study group included 69 men and 16 women, with a mean age of 57.5 ± 1.4 years. Results . In patients with pancreatic adenocarcinoma, DGE developed in 24% of cases, while in those with neuroendocrine tumors, it was observed in 75% of cases. Among patients with “soft” pancreatic parenchyma, DGE occurred in 28.6%, whereas in those with “firm” parenchyma, the incidence was 19.2%. Correlation analysis between parenchymal characteristics and the development of DGE showed statistical significance (P ≤ 0.05). Discussion . In patients with tumors in the periampullary region, the overall incidence of DGE was 23.5%. The identified risk factors for DGE included pancreatic parenchymal consistency, presence of obstructive jaundice, tumor histotype, and patient age. Early recognition of these risk factors may enable preventive measures against DGE in the postoperative period. Prophylactic administration of erythromycin, as recommended by randomized trials, accelerates the resolution of DGE, which was confirmed by clinical outcomes. Conclusion . Gastro-pancreaticoduodenal resection is one of the most complex operations in abdominal surgery, both technically and postoperatively. It carries a high risk of complications. Identifying risk factors may help elucidate the mechanisms behind complications such as delayed gastric emptying and pancreatic fistulas.