Gastric Acid Secretion After Pancreaticoduodenectomy

Waddell, William R.

doi:10.1001/archsurg.1968.01330220090016

Cited by 21 publications

(2 citation statements)

References 5 publications

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“…The etiology of marginal peptic ulcer after PD is considered to be related to the altered gastrointestinal anatomy along with other conventional causes, such as gastric acidity, NSAID therapy, and Helicobacter pylori infection [5,[8][9][10][11]. Several acid-inhibiting hormones, such as secretin, gastric inhibitory polypeptide, and vasoactive intestinal peptide, are mainly produced in the small bowel, especially near the stomach [5].…”

Section: Discussionmentioning

confidence: 99%

Perforation of anastomotic peptic ulcer following pancreaticoduodenectomy: a report of three cases

et al. 2020

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Background: Perforation of a marginal peptic ulcer after pancreaticoduodenectomy (PD) can lead to severe conditions, although its clinical features have not been well reported. In this article, we present three cases of marginal peptic ulcer perforation after PD that we experienced in our institute and attempt to clarify its appropriate treatment and prevention. Case presentation: Marginal ulcer perforation confirmed with computed tomography and/or surgical exploration occurred in 3 (1.8%) of 163 consecutive patients who underwent PD (including 160 patients who underwent a total or subtotal stomach-preserving procedure) at our institution. The three patients (one man and two women) had a median age of 77 (65-79) years. Two of these patients had a medical history of duodenal peptic ulcer. All three patients had biliary neoplasms. Two of the patients underwent subtotal stomach-preserving PD with antro-jejunal anastomosis, and the other patient underwent pylorus-preserving PD with duodenal jejunostomy. The perforation occurred with a sudden and severe onset of abdominal pain 34, 94, and 1204 days, respectively, after the PDs. At the time of the perforation, all of the patients had been withdrawn from postoperative prophylactic antipeptic ulcer agents, with the cessation periods ranging from 12 to 1008 days. In addition, all the patients were in fasting conditions for 1 to 13 days just before the perforation. Surgical treatment with direct suturing of the perforated ulcer was performed for two patients, while conservative therapy was performed for one patient. Their primary treatment courses were satisfactory. Chronic antisecretory agent therapy was prescribed for 562, 271, and 2370 days, respectively, from marginal ulcer perforation, and no ulcer recurrence was noted in any of the patients. Conclusions: Lack of antisecretory therapy and fasting were considered an essential cause of marginal peptic ulcer perforation after PD. In addition, unlike the native duodenum, the jejunal limb used for reconstruction to a preserved stomach may be at increased risk of ulceration. Chronic permanent administration of antisecretory agents and fasting avoidance are desirable for patients who have undergone stomach-preserving PD to prevent marginal ulcer perforation.

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Section: Discussionmentioning

confidence: 99%

Perforation of anastomotic peptic ulcer following pancreaticoduodenectomy: a report of three cases

et al. 2020

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“…The addition of truncal vagotomy, a common accompaniment of pancreaticoduodenectomy, advocated by Grant and van Heerden22 and by Waddell and Loughry,23 to avoid marginal ulcers at the gastrojejunostomy anastomosis, can also significantly increase steatorrhea. Edwards et al24 found that, in patients undergoing pyloroplasty, the incidence of steatorrhea was 8% after highly selective vagotomy and 45% after truncal vagotomy.…”

Section: Pylorus‐preserving Pancreaticoduodenectomy Versus Standard Pmentioning

confidence: 99%

Pylorus-preserving pancreaticoduodenectomy for pancreatic and peripancreatic malignancies: A 1996 perspective

Frey

1997

J Hep Bil Pancr Surg

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Pylorus-preserving pancreaticoduodenectomy, based on review of the literature, conveys little, if any, measurable benefit over the standard operation with regard to nutrition and metabolism. Some of the benefits attributed to pylorus preservation by Traverso may be due instead to his use of a duct-to-mucosa pancreaticojejunostomy anastomosis which preserves pancreatic function. Comparisons of the standard and pylorus-preserving operation in regard to metabolic, nutritional, and postgstrectomy syndromes are hindered by a lack of uniformity from one report to another regarding the type of pancreaticojejunostomy anastomosis performed, the amount of stomach resected, whether vagotomy was or was not performed, and whether a Billroth I ,br II gastrojejunostomy or duodenojejunostomy was performed. Pyloruspreserving pancreaticoduodenectomy can be used safely in the management of about 85% of patients with pancreatic and distal common bile duct cancer and in 95% of those with ampullary cancer. The standard operation should be used in the presence of any sign of tumor infiltration of the duodenal bulb or peripyloric lymph nodes. Japanese surgeons have emphasized the utility of employing the Billroth I rather than Billroth If anastomosis after pancreaticoduodenectomy, as it provides access to visualize endoscopically the pancreaticojejunostomy and choledochojejunostomy anastomosis.

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