Abstract
Twenty patients underwent a pylorus-preserving pancreatoduodenectomy for benign or malignant periampullary and pancreatic disease. Eighteen patients had a partial and two patients a total pancreatectomy. There were 19 elective and 1 emergency operations. Post-operative mortality was 4% (1/20 patients) and the median follow up was 31 months (range, 15– 75 months), during which period 8 patients with a malignant disease died. Pylorus-preserving pancreatoduodenectomy did not compromise survival in ampullary cancer. One patient developed a marginal ulcer during the study period and one of twelve patients, examined by technetium scintigraphy (done more than 3 months after the procedure), had delayed gastric emptying. Two patients presented with a gastric retention as the first sign of recurrent pancreatic cancer. The result of the operation was judged as excellent in 7 patients, good in 8 and as bad in only 2 of the 17 patients who survived more than 6 months . Body weight was studied in 15 patients surviving more than one year after operation; five patients had gained weight, two had lost weight and in 8 there was no difference. Pylorus-preserving pancreatoduodenectomy seems to be a valuable alternative in the treatment of patients with benign and selected malignant pancreaticobiliary disease.
Highlights
Kausch and Whipple performed the first successful pancreatoduodenal resections (PDR) with preservation of the entire stomach and a gastrojejunostromy was performed for restoration of the gastro-intestinal continuity[4]
Watson described pyloruspreserving PDR (PP-PDR) in 1942, it was not until 1978 that the metod was popularized by Longmire[25]
None of 18 patients treated by partial PDR died; one of the two patients undergoing total pancreatectomy for pancreatic cystadenoma died of a pulmonary embolism on the first postoperative day
Summary
Kausch and Whipple performed the first successful pancreatoduodenal resections (PDR) with preservation of the entire stomach and a gastrojejunostromy was performed for restoration of the gastro-intestinal continuity[4]. Because of the ulcerogenic nature of the operation and because of oncological reasons, partial gastric resection was added to the procedure. Watson described pyloruspreserving PDR (PP-PDR) in 1942, it was not until 1978 that the metod was popularized by Longmire[25]. The goal of this latter procedure was to decrease morbidity (a consequence of the reduced gastric reservoir) and to improve the nutritional status of the patient. Because of the success of the procedure in benign periampullary diseases9’26, the indications have been widened to include malignant disease[4,11].
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