Long‐term evaluation of pylorus preservation during pancreaticoduodenectomy

Abstract

Although pyloric preservation can be performed during pancreaticoduodenectomy without increased morbidity or mortality or decreased survival, the long-term benefit of this technique remains unproven. In this study, the functional status of patients recovered from pyloric-preserving pancreaticoduodenectomy was evaluated by comparing 6 long-term survivors of the standard Whipple procedure (1-7 years postoperative; mean. 4.7 yr) to a similar group of 6 patients recovered from pylorus preservation pancreaticoduodenectomy (1-7 years postoperative: mean. 3.0 yr/. All patients completed a questionnaire evaluating postgastrectomy symptoms. Fasting blood specimens were obtained for hematologic and biochemical analysis. Ten of the 12 patients then underwent endoscopy; perianastomotic and midgastric biopsies were graded for inflammation. Gastric emptying of both liquid and solid phases was measured with an isotopically-labeled meal. Gastric emptying data were compared between groups and also to a group of 7 normal controls studied previously using the same methodology. Analysis of questionnaire results and mean laboratory values revealed no significant differences between the 2 surgical groups. Serum carotene levels were low in most patients. Several patients demonstrated abnormal indices of iron homeostasis. No significant abnormalities were noted on endoscopic examinations and biopsy results did not differ between the 2 surgical groups. Liquid gastric emptying was significantly prolonged in patients following standard pancreaticoduodenectomy (h/2 = 98.3 -+ 26.2 min) as compared to pylorus preservation patients (h/2 = 37.5 _+ 10.9 min) or normal controls (tl/2 = 33.1 -+ 2.8 min~. We conclude that. in the long-term, pylorus preservation appears to be at least functionally equivalent to the standard pancreaticoduodenectomy. As such. we believe that pyloric preservation. obviating vagotomy and gastric resection, deserves consideration during pancreaticoduodenectomy.

The Role of Pylorus-Preserving Duodenopancreatectomy in Pancreatic Cancer

“…(5) Still there is some concern of delayed gastric emptying in pylorus-pre serving technique based on early publications. Recent data, however, do not any longer continue to support this finding but show an equal occurrence rate of delayed gas- trie emptying between the pylorus-preserving duodeno pancreatectomy and the standard Whipple [23][24][25]. The reason for this may again be the careful preservation of pyloric innervation and perfusion.…”

Outcome of Pancreaticoduodenectomy With Pylorus Preservation or With Antrectomy in the Treatment of Chronic Pancreatitis

“…24,33 As a result, emptying of liquids takes a significantly shorter time after PPPD than after Whipple resection. 34,35 Likewise, physiologic measurements of serum gastrin have been shown to be nearly normal after PPPD but markedly depressed after standard Whipple (in which antrectomy removes the source of gastrin). 21,36 Other, more ambitious studies have failed to demonstrate nutritional advantages in terms of glucose homeostasis and iron absorption.…”

“…21,36 Other, more ambitious studies have failed to demonstrate nutritional advantages in terms of glucose homeostasis and iron absorption. 34 In general, most studies have used postoperative patient weights as parameters of nutritional status and have reported weight gain in 67% to 95% of patients after PPPD. 13,16,37,38 Our data, however, demonstrate no differences in nutritional parameters between the two procedures.…”

Which Is the Better Operation in Chronic Pancreatitis: Pylorus-Preserving Whipple or Duodenum-Preserving Pancreatic Head Resection?

“…Martin et al [38] reported an endoscopic or radiologic diagnosis of ulcers in 6 of 126 patients (5%). Fink et al [39] also found a 5% incidence of marginal ulceration in a follow-up of 40 patients. Higher incidences of 10-19% are reported by other authors in follow-up studies 30-60 months after the pylorus-preserving Whip ple [26,[30][31][32].…”