Abstract
Introduction Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PD), associated with prolonged hospitalization and delayed initiation of adjuvant therapy. Surgical reconstruction technique may influence postoperative gastric motility. This single-center study evaluated the association between the type of PD (classical vs. pylorus-preserving PD (PPPD)) and the incidence of DGE in patients undergoing standardized retrocolic Billroth II reconstruction for malignant disease. Materials and methods We conducted a retrospective observational study of 15 patients who underwent PD for malignant disease between June 2021 and June 2022 at a tertiary oncology center. All patients underwent retrocolic Billroth II reconstruction. Clinically relevant DGE (grades B and C) was defined according to the International Study Group of Pancreatic Surgery criteria. Results DGE occurred in 46% (7/15) of patients overall. The incidence was significantly higher after classical PD (77.8%, 7/9) compared with no cases in the PPPD group (0/6; p = 0.007). Among patients with DGE, 28.6% (2/7) tolerated solid intake before postoperative week three, while 71.4% (5/7) did so after week three. Ninety-day mortality was 0% in both groups. At study closure, overall survival was 77.8% in the classical PD group and 100% in the PPPD group (p = 0.642), reported descriptively due to the limited sample size. Conclusion PPPD appeared to be associated with a lower frequency of clinically relevant DGE after standardized retrocolic Billroth II reconstruction. These preliminary findings suggest that meticulous, tension-free reconstruction may help optimize postoperative gastric motility. Larger studies are needed to validate these exploratory observations.