Comparison between pylorus-preserving and Whipple pancreatoduodenectomy

Abstract

Between 1989 and 1993, 62 patients underwent Whipple pancreatoduodenectomy and 75 pylorus-preserving pancreatoduodenectomy (PPPD); 35 patients in the first group and 37 in the second had pancreatic adenocarcinoma while 17 and 21 patients respectively had periampullary adenocarcinoma. The aim of this retrospective study was the comparison of operative outcome, nutritional recovery and survival of patients who underwent these two operations. No significant differences were found between the two groups in operative mortality or morbidity, duration of gastric aspiration and time to start of solid meals. Patients who underwent PPPD had a better nutritional recovery: the increase of both body-weight and serum albumin level at 6 months after discharge was significantly higher for those who had preservation of the whole stomach (P < 0.001 and P < 0.05 respectively). No significant difference in survival was found between the two procedures when patients with pancreatic or periampullary adenocarcinoma were analysed separately.

Clinical and nutritional status in the late postoperative of pancreaticoduodenectomy: influence of pylorus preservation procedure

“…However, the pylorus preservation seems to have advantages in the functional and nutritional status 3,8 . A longitudinal follow-up showed that differences in postoperative weight gain are correlated rather with resection margins and tumor recurrence than with the type of resection 5 .…”

“…In recent decades, several studies have been conducted to evaluate clinical and nutritional longterm effects after PD [3][4][5][6][7][8] . However, most studies have not made a complete nutritional assessment and they do not describe digestive complaints or details of food intake patterns.…”

Delayed Gastric Emptying After Standard Pancreaticoduodenectomy Versus Pylorus-Preserving Pancreaticoduodenectomy: An analysis of 200 Consecutive Patients

“…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.…”

“…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.…”

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

“…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.…”