Gastrointestinal function and quality of life after pylorus-preserving pancreatoduodenectomy

Abstract

The pylorus-preserving pancreatoduodenectomy (PPPD) has taken the place of the conventional Whipple pancreatoduodenectomy as the standard procedure for various periampullary disease. With recent advances in surgical techniques and improvements in perioperative management, the number of long-term survivors after PPPD is increasing. As a result, surgeons should pay more attention to the patients' postoperative gastrointestinal function, nutrition, and quality of life (QOL). Gastric stasis, which is a frequent complication during the early postoperative period after PPPD, prolongs the hospital stay and impairs the QOL in the intermediate term. Several possible pathogeneses for this gastric stasis have been postulated; however, the precise mechanism remains unclear. The gastric emptying function gradually recovers to the preoperative level by 6 months after PPPD. Pancreatic functions are likely to be maintained for at least 1 year after PPPD; however, in some cases, they tend to gradually deteriorate over time after the operation, depending on the type of pancreatic reconstruction or the preoperative condition of the pancreas. It is important to note that preoperative and postoperative pancreatic exocrine function strongly influence the postoperative outcome regarding such factors as pancreatic fistula, body weight maintenance, nutrition, and the QOL. The QOL, as assessed by questionnaire, normally returns to the preoperative level within 6 months after PPPD, and this correlates with the changes in gastrointestinal function and nutritional status. It still remains an unresolved question, however, whether the Billroth-I PPPD really leads to better long-term nutritional status, but worse early gastric emptying function, than the Billroth-II type of reconstruction.

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

“…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.…”

Low-pressure continuous suction of bile and pancreatic juice from the hepatic duct and jejunal limb after major hepatectomy with pancreatoduodenectomy

“…[10][11][12][13][14] However, it still carries a risk of several potentially lethal complications, such as intraabdominal hemorrhage and abscess following anastomotic leakage of the pancreaticojejunostomy. In fact, the morbidity rate associated with complications of PD ranges from 18% to 52%.…”

Gastrointestinal Motility After Digestive Surgery

“…[48][49][50] However, early gastric stasis occurs in 30%-50% of patients undergoing PPPD, causing prolonged loss of large amounts of gastric juice, delayed resumption of oral intake, and extended hospitalization. [48][49][50][51] The possible factors responsible for gastric stasis after PPPD are ischemic and neural injury to the antropyloric muscle, 52 gastric dysrhythmia, 53 and gastric atony after resection of a duodenal pacemaker, or the reduced circulating levels of motilin. 54 The duodenum plays an important role in initiating the gastric migrating motor complex and in coordinating interdigestive GI motor activity, possibly by the release of motilin.…”