Cakir Mikail, Akinci Muzaffer, Akturk Okan Murat
University of Health Sciences Haseki Training and Research Hospital, Department of General Surgery, Istanbul, Turkey.
Medeni Med J. 2020;35(3):181-187. doi: 10.5222/MMJ.2020.02222. Epub 2020 Sep 30.
Whipple's procedure for periampullary tumors has significant risks and complications. Delayed gastric emptying has the highest rate. Although the International Study Group of Pancreatic Surgery defined (ISGPS) this entity, multiple definitions still exist among authors. This study aims to revise the definition.
Seventy-three consecutive patients were analyzed for complications, particularly delayed gastric emptying. All patients underwent a standardized surgery. Procedures used for total pancreatectomies and benign diseases were excluded.
A total of 73 patients were included in the study. Intra-abdominal complications were observed in 15 (20.6%) patients. Grade C delayed gastric emptying was observed in only one (1.4%) patient. Grade A and B disease were observed in three (4.1%) patients. However, they responded well to conservative methods, causing no extra morbidity.
Grade A and B delayed gastric emptying can be observed after any gastrointestinal surgery. These patients respond well to simple conservative methods with nasogastric intubation. Drainage of the intra-abdominal collection resolves the emptying problem (if any). Only grade C disease without other intra-abdominal complications can be accepted as a complication of this procedure. ISGPS definition does not include the cause. Thus, the definition and grading can be revised.
针对壶腹周围肿瘤的惠普尔手术存在重大风险及并发症。胃排空延迟的发生率最高。尽管国际胰腺手术研究小组（ISGPS）对该病症进行了定义，但作者之间仍存在多种定义。本研究旨在修订该定义。
对连续73例患者的并发症，尤其是胃排空延迟情况进行分析。所有患者均接受标准化手术。排除全胰切除术及良性疾病所采用的手术。
本研究共纳入73例患者。15例（20.6%）患者出现腹腔内并发症。仅1例（1.4%）患者出现C级胃排空延迟。3例（4.1%）患者出现A级和B级病症。然而，他们对保守治疗反应良好，未引发额外的发病率。
任何胃肠道手术后均可观察到A级和B级胃排空延迟。这些患者对鼻胃管插管等简单保守治疗方法反应良好。腹腔内积液引流可解决排空问题（如有）。仅无其他腹腔内并发症的C级病症可被视为该手术的并发症。ISGPS定义未涵盖病因。因此，可对定义及分级进行修订。
