Pancreatogastrostomy: An ideal complement to pancreatic head resection with preservation of the pylorus in the treatment of chronic pancreatitis

Flautner, L; Tihanyi, Tibor; Szécsény, A

doi:10.1016/0002-9610(85)90446-5

Cited by 73 publications

(58 citation statements)

References 6 publications

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“…Yamashita et al (1981) interposed the uppermost part of the remaining jejunum, 40 cm in length, between the remaining stomach and the Roux-en-Y loop of the jejunum, and reported that the pancreatic exocrine secretion was preserved well. After Traverso and Longmire (1978) devised the pylorus-preserving procedure, several modifications have been done on the method (Flautner et al 1985; Kim et al 1987;Takada et al 1989). Kim et al (1987) anastomosed the duodenal bulb to the stump of the jejunum as the method of Watson (1944), and both the bile and pancreatic ducts to the upper jejunum as the method of Imanaga (1960).…”

Section: Discussionmentioning

confidence: 99%

“…Kim et al (1987) anastomosed the duodenal bulb to the stump of the jejunum as the method of Watson (1944), and both the bile and pancreatic ducts to the upper jejunum as the method of Imanaga (1960). Takada et al (1989) also did the reconstruction in the Billroth-I type after the pyloruspreserving pancreato-duodenectomy, but the pancreatic duct was anastomosed to the stomach as the method of Flautner et al (1985). In contrast to the classical Whipple's procedure, in the pylorus-preserving pancreatoduodenectomy the function of the stomach, such as reserving, mixing and finally breaking down food, can be preserved, and bring about better nutritional status (Suzuki et al 1988).…”

Section: Discussionmentioning

confidence: 99%

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Alimentary Tract Reconstruction following Pancreatoduodenectomy: A New Method with Improvements in the Nutritional State and Gastrointestinal Hormone Release in Dogs.

Imamura¹,

Yamauchi²,

Kakizaki³

1991

Tohoku J. Exp. Med.

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Experiments were performed on adult beagle dogs to investigate the nutritional state and the release of gastrointestinal hormones after pancreatoduodenectomy. A new variation of reconstruction of the alimentary tract was devised and compared with the classical Child's method. In our method, the remaining stomach was anastomosed to the oral stump of the jejunum in an end-to-end fashion. A short mid-intestinal segment was interposed between the pancreatic and bile ducts and the upper jejunum. During the observation period of six months after surgery, the loss of body weight was significantly smaller in the new method, and the frequency of both morbidity and mortality was lower. Although perforated stomal ulcer was observed in one dog after the Child's method, no peptic ulcer was detectable after our method. The integrated increase of plasma triglyceride in response to ingested butter was slightly greater in our method than in the Child's. At six weeks after surgery, plasma concentrations of both cholecystokinin and secretin, not only during fasting but after intake of butter, were augmented in both groups, particularly in the group receiving the new method. These results indicate that retaining the remaining upper small intestine as the food pathway is effective in maintaining good nutritional state, and in facilitating the release of gastrointestinal hormones.dog ; pancreatoduodenectomy ; alimentary tract reconstruction ; cholecystokinin ; secretin The typical pancreatoduodenectomy procedure involves a massive resection of the digestive organs in the upper abdomen : the resection of the distal stomach, the duodenum, the upper jejunum, the gallbladder and the bile duct together with the head of the pancreas. As a result, a number of undesirable consequences, such as maldigestion of nutrients, glucose intolerance and disturbances in bone metabolism have been brought about (Miyata et al. 1974;Sato et al. 1986;Yagi et al.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Alimentary Tract Reconstruction following Pancreatoduodenectomy: A New Method with Improvements in the Nutritional State and Gastrointestinal Hormone Release in Dogs.

Imamura¹,

Yamauchi²,

Kakizaki³

1991

Tohoku J. Exp. Med.

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“…Recently the organ-preserving procedures (Beger, Frey and PPPD operations) have become popular in the surgical treatment of chronic pancreatitis with head enlargement and the traditional Whipple procedure no longer has a place in this disease [8, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25]. However, there are some differences between these organ-saving operations.…”

Section: Discussionmentioning

confidence: 99%

“…The first step was the preservation of the pylorus [6, 7, 8]. The most physiological method is to save the whole duodenum.…”

Section: Introductionmentioning

confidence: 99%

Clinical Experience with Different Techniques of Pancreatic Head Resection for Chronic Pancreatitis / with Invited Commentary

Kelemen

Horváth

2002

Dig Surg

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Background/Aims: Recently organ-saving procedures have become popular in the treatment of chronic pancreatitis with head enlargement. The purpose of this study is to compare the results of three different procedures. Methods: Between 1991 and 1998, 32 Beger operations, 13 Frey procedures and 21 pylorus-preserving pancreatoduodenectomies (PPPDs) were performed. The pre-, intra- and postoperative data were detailed. During the follow-up examination the quality of life, body weight, consumption of alcohol and enzymes, as well as the carbohydrate metabolism were checked. Results: Considering the operative and late mortality and reoperation rate, there was no difference between the procedures. The postoperative hospitalization time was the shortest after the duodenum-preserving pancreatic head resections (Beger and Frey). While the rate of early morbidity was higher after PPPDs, there was no difference in late morbidity between the groups. The condition of the patients was better and the development rate of diabetes was lower after the Beger procedure than after PPPDs. Conclusion: Consequently duodenum-preserving pancreatic head resections seem to be more advantageous than PPPD. Nevertheless the latter operation is the only possibility in some situations.

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“…The first PG in humans was performed in 1944 [28] . Since then, several series with around 3800 patients have been published [29][30][31] , and their outcomes have been compared in some papers with those of PJ to determine the best reconstructive technique.…”

Section: Pancreatogastrostomymentioning

confidence: 99%

Reconstruction after pancreatoduodenectomy: Pancreatojejunostomyvspancreatogastrostomy

Gómez¹

2014

WJGO

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Pancreatic surgeons try to find the best technique for reconstruction after pancreatoduodenectomy (PD) in order to decrease postoperative complications, mainly pancreatic fistulas (PF). In this work, we compare the two most frequent techniques of reconstruction after PD, pancreatojejunostomy (PJ) and pancreatogastrostomy (PG), in order to determine which of the two is better. A systematic review of the literature was performed, including major meta-analysis articles, clinical randomized trials, systematic reviews, and retrospective studies. A total of 64 articles were finally included. PJ and PG are usually responsible for most of the postoperative morbidity, mainly due to the onset of PF, being considered a major trigger of life-threatening complications such as intra-abdominal abscess and hemorrhagia. The included systematic reviews reported a significant difference only in the incidence of intraabdominal collections favouring PG. PF, delayed gastric emptying and mortality were not different. Although there was heterogeneity between these studies, all were conducted in specialized centers by highly experienced surgeons, and the surgical care was likely to be similar for all the studies. The disadvantages of PG include an increased incidence of delayed gastric emptying and of main pancreatic duct obstruction due to overgrowth by the gastric mucosa. Exocrine function appears to be worse after PG than after PJ, resulting in severe atrophic changes in the remnant pancreas. Depending on the type of PJ or PG used, the PF rate and other complications can also be different. The best method to deal with the pancreatic stump after PD remains questionable. The choice of method of pancreatic anastomosis could be based on individual experience and on the surgeon's preference and adherence to basic principles such as good exposure and visualization. In conclusion, up to now none of the techniques can be considered superior or be recommended as standard for reconstruction after PD. Core tip: Pancreatoduodenectomy is a technique with a high rate of morbidity and mortality. Surgeons try to find the best technique of reconstruction in order to decrease postoperative complications. We compare the two most frequent techniques of reconstruction after pancreatoduodenectomy, namely pancreatojejunostomy and pancreatogastrostomy, to determine which of the two is better. We offer a systematic review of the main papers published with all the pros and cons of each technique. The best method to deal with the pancreatic stump after pancreatoduodenectomy remains questionable. The choice of method of pancreatic anastomosis could be based on individual experience and on the surgeon's preference and adherence to basic principles, such as good exposure and visualization. TOPIC HIGHLIGHTSeptember 15, 2014|Volume 6|Issue 9|

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Pancreatogastrostomy: An ideal complement to pancreatic head resection with preservation of the pylorus in the treatment of chronic pancreatitis

Cited by 73 publications

References 6 publications

Alimentary Tract Reconstruction following Pancreatoduodenectomy: A New Method with Improvements in the Nutritional State and Gastrointestinal Hormone Release in Dogs.

Alimentary Tract Reconstruction following Pancreatoduodenectomy: A New Method with Improvements in the Nutritional State and Gastrointestinal Hormone Release in Dogs.

Clinical Experience with Different Techniques of Pancreatic Head Resection for Chronic Pancreatitis / with Invited Commentary

Reconstruction after pancreatoduodenectomy: Pancreatojejunostomyvspancreatogastrostomy

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