August 1994

Invited Commentary

Author Affiliations

Cape Town, South Africa

Arch Surg. 1994;129(8):799. doi:10.1001/archsurg.1994.01420320021002

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Delayed gastric emptying is one of the most important causes of morbidity after palliative gastric bypass surgery for carcinoma of the pancreas. The incidence varies widely in reported series, and the mechanism remains obscure. The problem is encountered not only when a gastroenterostomy is performed for overt duodenal obstruction but also after a prophylactic bypass. Indeed, symptoms of delayed gastric emptying are a feature in many patients with advanced carcinoma of the pancreas without evidence of overt duodenal encroachment. Even in asymptomatic patients, solidphase gastric emptying studies have shown delayed emptying. The factors governing delayed gastric emptying in carcinoma of the pancreas are complex and in some situations may be aggravated by the addition of a gastroenterostomy. The excellent functional results achieved in this study, using A/BII anastomosis in patients with advanced disease, would suggest that antral malfunction is a major contributing factor in delayed gastric emptying. The explanation for

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