- Design
- Prospective, randomised, open-label trial at 2 high-volume French centres, 90-day follow-up
- Population
- 158 adults undergoing pancreatoduodenectomy, 79 per group
- Primary outcome
- Delayed gastric emptying
- Effect
- 38.0% vs 30.4%; RR 1.25 (95% CI 0.81 to 1.94), P = 0.314
The IPAD trial randomised 158 adults having pancreatoduodenectomy for benign or malignant disease, at two high-volume French centres, to side-to-side or end-to-side gastrojejunostomy during the operation, with 90 days of follow-up. It was open-label.
Delayed gastric emptying occurred in 38.0% after side-to-side and 30.4% after end-to-side reconstruction (risk ratio 1.25, 95% CI 0.81 to 1.94, P = 0.314). Pancreatic fistula, biliary fistula, reintervention and mortality were similar, and nutritional outcomes and quality of life at 90 days did not differ (GIQLI 87.9 against 86.6).
The interval is wide enough to allow a clinically important difference either way, so the trial shows no proven advantage for either technique rather than equivalence. Retrospective hints in favour of a side-to-side anastomosis were not confirmed.
- Either configuration is reasonable; surgeon experience and local practice can guide the choice
- Delayed gastric emptying remains common at over 30%, so plan nutrition and prokinetic strategies
- Review postoperative feeding routes early in patients with delayed emptying
- Larger trials would be needed to detect a smaller difference
Why it matters
Delayed gastric emptying is among the commonest complications of pancreatic surgery, and retrospective data had suggested a technical fix.
Don't overread it
A negative trial of 158 patients does not prove the techniques are equivalent.
The statistics, in plain English
A risk ratio of 1.25 with an interval from 0.81 to 1.94 means the data are compatible with a 19% reduction or a 94% increase in delayed emptying with side-to-side reconstruction. With 79 patients per group, the trial cannot exclude moderate differences.
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