Pyloric and Gastric Preserving Pancreatic Resection

Abstract

Eighty-seven patients with neoplasm (57 cases), pancreatitis (28 cases), or benign biliary obstruction (2 cases) were treated with pyloric preserving pancreatectomy with two postoperative deaths, neither due to abdominal complications. About 50% of patients had delay in recovery of gastrointestinal function. Six and seven patients had clinically significant biliary and pancreatic fistulas, respectively, with some patients having both. Complications required 16 reoperations. Marginal ulcer was suggested by endoscopy or barium study in five patients, three of whom were successfully managed by a medical regimen. In the other two patients, exploration failed to demonstrate an ulcer or jejunitis. In most patients, long-term gastrointestinal function was judged to be excellent based on weight gain and lack of digestive symptoms. Pyloric function and gastric motility were evaluated by abdominal scanning using indium 111 and technetium 99m. Gastric emptying of liquids and solids was normal. Estimations of enterogastric reflux showed a moderate difference between normal subjects and pancreatectomy patients. Cancer-free survival was comparable to that after the standard Whipple procedure.

Delayed Gastric Emptying After Standard Pancreaticoduodenectomy Versus Pylorus-Preserving Pancreaticoduodenectomy: an Analysis of 200 Consecutive Patients

“…The wide range in the incidence of delayed gastric emptying after PD and PPPD, varying at 25-70%, seems related to the different criteria for gastric function set by the authors of different reports. [12][13][14][15][16][17]19,25 In the present series, the patients required longer nasogastric intubation after PPPD than after PD. Although these results suggest some form of early gastric stasis after PPPD, it did not result in an overall increase in the incidence of delayed gastric emptying.…”

“…3,4,[9][10][11] A less serious complication is delayed gastric emptying, which is reported to occur at 25-70% after pancreaticoduodenectomy, with an average of 30%. 4,[12][13][14][15][16][17][18][19] Although delayed gastric emptying is not associated with mortality, it can be a troublesome complication and can jeopardize nutritional status when patients do not receive enteral or parenteral nutrition. It also increases the postoperative hospital stay.…”

“…It also increases the postoperative hospital stay. 12,16,19 The variation in the incidence of partly delayed gastric emptying that is reported is probably due to the fact that no uniform definition exists. Some authors have defined delayed gastric emptying as the inability to tolerate a regular or normal diet by the fourteenth 4 or the tenth postoperative day [14][15][16] or the start of a liquid diet after Ն7 days.…”

“…Some authors have defined delayed gastric emptying as the inability to tolerate a regular or normal diet by the fourteenth 4 or the tenth postoperative day [14][15][16] or the start of a liquid diet after Ն7 days. 13 Others have described delayed gastric emptying as gastric stasis requiring gastric suction for 7 days 18,19 or Ն10 days. 12,17 Pylorus-preserving pancreaticoduodenectomy (PPPD) is considered a good alternative to standard pancreaticoduodenectomy, or Whipple's procedure (PD).…”

“…Most reports have shown similar survival for the two techniques, and PPPD is now generally accepted as an equally effective procedure for pancreatic or periampullary tumors. 6,17,[19][20][21] A few studies have reported that PPPD leads to a shorter operative time, less blood loss, and a lower intraoperative need for transfusion. 6,22 According to some authors, however, PPPD is associated with an increased incidence of delayed gastric emptying.…”