Effect of Right-to-Left (Isoperistaltic Anastomosis) or Left-to-Right (Antiperistaltic Anastomosis) Gastrojejunostomy Technique on the Delayed Gastric Emptying After the Whipple Surgery

Document Type : Original Article


Department of Surgery, School of Medicine, Jundishapur University of Medical Science, Ahvaz, Iran



Objectives: Delayed Gastric Emptying (DGE) after the Whipple surgery is a common
problem. This study aimed to compare the efficacy of Right to Left (R-to-L) (isoperistaltic
anastomosis) gastrojejunostomy versus Left to Right (L-to-R) (antiperistaltic anastomosis) in
DGE after the Whipple surgery.
Methods: In this clinical trial, 60 patients referred to Golestan and Arvand Hospital in Ahvaz
City, Iran, who needed Pancreaticoduodenectomy (PD) or the Whipple procedure were recruited
in our study and divided into two groups. The first group underwent gastrojejunostomy with
isoperistaltic as R-to-L anastomosis and the second group antiperistaltic as L-to-R anastomosis.
The two groups were compared one month after surgery for DGE severity, NPO (Nothing by
mouth) duration, hospital stay duration, TPN (total parenteral nutrition) requirement, and rehospitalization
Results: DGE intensity in R-to-L decreased significantly compared to L-to-R (intensity: 5 [16.7%]
vs 13 [43.5%]; P<0.001). In particular, the intensity difference was as follows: grade A=10%,
grade B=6.7%, grade C=0%, versus grade A=20%, grade B=13.3%, grade C=10% (P<0.001).
NPO duration and hospital stay in R-to-L were significantly lower than L-to-R (NPO: 3.1 vs 4.7,
P=0.028; hospital stay: 4.3 vs. 7.8; P=003). The re-hospitalization rate in R-to-L was lower than
in the other group (1 [3%] vs 8 [26.7%]; P<0.001). None of the R-to-L patients required TPN, but
16.7% of the L-to-R group required TPN, a significant difference (P<0.001).
Discussion: R-to-L gastrojejunostomy significantly reduces the delay in gastric emptying after
the Whipple operation for a periampullary tumor.


Milad Arabi (PubMed)(Google Scholar)

Amin Bahreini (PubMed)(Google Scholar)


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