Are biochemical pancreatic leaks benign? Association with primary delayed gastric emptying.

Abstract

Delayed gastric emptying is a common complication after pancreaticoduodenectomy that leads to significant morbidity and resource utilization. The aim of this study was to determine the factors associated with primary and secondary delayed gastric emptying. This was a single-institution, retrospective study (2020-2023) of patients undergoing pancreatectomy. Patients were classified as having no delayed gastric emptying, primary delayed gastric emptying, and secondary delayed gastric emptying (secondary to another intra-abdominal complication). Pre-, intra-, and postoperative factors were recorded to evaluate risk factors associated with delayed gastric emptying. Of 170 patients, 51 (30%) developed delayed gastric emptying, with 17.1% reported as primary delayed gastric emptying (n = 29). The average age of the overall cohort was 67 ± 11.4 years and there was no significant difference in demographics between groups. Patients with primary delayed gastric emptying were more likely to have undergone handsewn gastrojejunostomy (82.8%) than those with no delayed gastric emptying (58%) or secondary delayed gastric emptying (45.4%; P = .02). 37.9 (n = 11) Of patients with primary delayed gastric emptying, 37.9 (n = 11) had a grade A postoperative pancreatic fistula, compared with only 12.6% of patients with no delayed gastric emptying and 22.7% of patients with secondary delayed gastric emptying (P < .01). On multivariate regression handsewn gastrojejunostomy (OR, 7.3; 95% CI, 1.9-28.2; P < .01) and grade A postoperative pancreatic fistula (OR, 4.5; 95% CI, 1.5-14.1; P < .01) continued to have higher odds of primary delayed gastric emptying compared with those having no delayed gastric emptying. Primary delayed gastric emptying occurs in nearly 1 in 5 patients undergoing pancreaticoduodenectomy. Handsewn gastrojejunostomy reconstruction and grade A pancreatic leak, previously thought to be a benign entity, were associated with primary delayed gastric emptying. The association between grade A postoperative pancreatic fistula and primary delayed gastric emptying challenges the benign nature of these biochemical leaks.