Delayed gastric emptying in classic pancreaticoduodenectomy vs pylorus-sparing pancreaticoduodenectomy, a retrospective and prospective comparative study

Background & objectives: The standard surgical method for treating pancreatic cancer and periampullary tumors is pancreaticoduodenectomy, Classic Whipple and Pylorus-preserving pancreaticoduodenectomy were the two surgical options, we intended to compare the incidence of delayed gastric emptying between Classic Whipple and Pylorus-preserving pancreaticoduodenectomy. Methods: A retrospective and prospective comparative study included fifty patients who underwent elective surgical pancreaticoduodenectomy including both Classic Whipple or pancreaticoduodenectomy in Zheen and Par hospitals between 2019 and 2024, comparing the elements of delayed gastric emptying with the options of surgical techniques and pre-operative status of the patients. Results: Most (37 patients) underwent the Classic Whipple, and the rest (13 patients) underwent the pancreaticoduodenectomy, significantly 100% of the Pylorus-preserving pancreaticoduodenectomy group had delayed gastric emptying, whether of grade A, or B (69.2%, and 30.8% respectively), while, 35.1% of patients in the Classic Whipple group didn’t develop it (p = 0.029). Two patients in the Classic Whipple group developed pancreatic fistula, compared with 0% in the other group (p = 1.000). Three patients (8.1%) in the Classic Whipple group developed chyle leaks, compared with 0% in the other group (p = 0.558). Four patients (10.8%) in the Classic Whipple group developed wound infection, compared with 0% in the other group (p = 0.561). Conclusion: delayed gastric emptying incidence significantly associated more with Pylorus-preserving pancreaticoduodenectomy, putting in consideration the postoperative morbidity which was increased in classic Whipple resection patients. Pylorus-preserving pancreaticoduodenectomy appears to be safe and just comparable with the Classic Whipple procedure.