Pylorus-preserving pancreatoduodenectomy with Billroth I type reconstruction: a viable option for pancreatic head resection.

Abstract

The aim of this study was to investigate the efficacy of pylorus-preserving pancreatoduodenectomy (PPPD) versus standard pancreatoduodenectomy (PD). A cohort of 80 patients were studied for 5 years using prospectively gathered data. PPPD was performed in 48 (60%) patients, and the other 32 (40%) underwent a standard Whipple's operation with partial distal gastrectomy (PD). In all cases, the gastric or duodenal stump was anastomosed with the first loop of jejunum as a Billroth I-type reconstruction. Overall, morbidity in the cohort of patients consisted of 10 with a pancreatic fistula, 5 with postoperative hemorrhage, 5 with sepsis, 3 with delayed gastric emptying, 2 with an anastomotic leak, and 1 each with intraabdominal hematoma or myocardial infarction. Major morbidity associated with PPPD appeared in 8 of the 48 (16.7%) patients compared with 2 of 32 (6.3%) in the PD group. There were two deaths (4.2%) in the PPPD group and one (3.1%) in the PD group. The mean length of hospital stay was 14.6 days for PPPD versus 17.1 days for PD. Of the 48 patients in the PPPD group 7 (14.6%) had a hospital stay of more than 20 days versus 8 of the 32 (25%) in the PD group. Contrary to recent reports, in our series the PPPD patients had a shorter hospital stay; and overall, 3 of the 80 (3.75%) patients developed delayed gastric emptying, a relatively low rate. The pancreatic fistula rate was almost threefold higher in the PPPD group than in the PD group (but did not prolong the inpatient stay). This may be due to an intact antrum secreting higher quantities of gastrin.