Background/Purpose: Pancreaticoduodenectomy (PD) is the standard treatment for operable 
adenocarcinomas of the head of the pancreas, as well as for other periampullary tumors. Pylorus preserving 
pancreaticoduodenectomy (PPPD) is generally accepted as a standard operation for periampullary lesions. 
They encompass four different types of cancers: ampullary (ampulla of Vater), biliary (intrapancreatic distal 
part of the bile duct), pancreatic (head-uncinate process), and duodenal (from the second portion). Delayed 
gastric emptying (DGE) is one of the most common postoperative morbidities with rates of 15%-40%.
The aim of this work to find out which factors influence the development of DGE after the standard PD and 
PPPD. 
Methods: This prospective study was carried out on 60 patients from November 2008 to February 2012. The 
operations were done in the Surgery Unit of the Gastrointestinal Tract, at the Faculty of Medicine, Alexandria, 
Egypt. They were divided into 2 groups according to the type of operation which was PD and PPPD (each 30 
patients).
Results: DGE was the commonest postoperative complication occurred in 23 patients (42.6%). DGE was 
found in 7 patients (26.9%) out of 26 patients with antecolic fashion and in 16 patients (57.7%) out of 28 
patients with retrocolic fashion.
Conclusion: DGE is the commonest postoperative complication after the standard PD and PPPD and can be 
reduced by certain measures during the operation:
1. Preserving the right gastric artery and the associated nerves along the pylorus.
2. Gastrojejunostomy better done in an antecolic fashion.
3. Duodenojejunostomy is anastomosed better end-to-side.