Design: Randomised, open-label trial, two centres
Population: 158 adults undergoing pancreatoduodenectomy
Primary outcome: Delayed gastric emptying
Effect: 38.0% vs 30.4% (RR 1.25, 95% CI 0.81 to 1.94)

In the IPAD trial, 158 patients having pancreatoduodenectomy at two French high-volume centres were randomised during surgery to a side-to-side or end-to-side gastrojejunostomy.

Delayed gastric emptying occurred in 38.0% after side-to-side and 30.4% after end-to-side (RR 1.25, 95% CI 0.81 to 1.94). Pancreatic and biliary fistula, reintervention, mortality, nutrition and quality of life at 90 days were similar.

Retrospective series had suggested configuration matters. This randomised result does not support switching technique to prevent delayed emptying, though the trial was not large enough to rule out a modest difference.

Use the gastrojejunostomy configuration you perform most reliably
Do not expect a change in configuration alone to reduce delayed gastric emptying
Look to other contributors — pancreatic fistula, collections — when emptying is delayed
Plan early nutritional support for patients at high risk of delayed emptying

Why it matters

It removes one commonly cited technical fix for a frequent complication.

The statistics, in plain English

An RR of 1.25 with an interval of 0.81 to 1.94 crosses 1.0, so the trial found no difference, but a larger trial could still find a modest one in either direction.