A novel reconstructive technique for pylorus-preserving pancreaticoduodenectomy: avoidance of early postoperative gastric stasis.
In 30 patients a reconstructive technique was used after pylorus-preserving pancreaticoduodenectomy in which the anastomoses were constructed in the sequence: duodenojejunal, hepaticojejunal (8-10 cm distal) and finally duct-to-mucosa pancreaticojejunal to a separate Roux loop. Indications for surgery included periampullary tumours, (n = 13), carcinoma of the head of the pancreas (n = 10) and chronic pancreatitis (n = 4). No patient required prolonged (> 7 days) nasogastric intubation for primary gastroparesis in the early postoperative period. Postoperative morbidity (17% overall) delayed recovery and return of gastrointestinal function in one patient with a minor biliary leak (closed with 5 days' somatostatin treatment). Other morbidity included gastrointestinal haemorrhage (n = 1), wound infection (n = 2) and respiratory infection (n = 2). There were no pancreatic leaks. One patient died from a subhepatic abscess (mortality 3%). Retrospective investigations, at 3-18 months postoperatively, included endoscopy (normal in 20 patients, none taking anti-ulcer therapy), gastric emptying studies in the first 10 patients (no delay) and bentiromide test in 12 patients considered to have normal pancreatic remnants (all patients > 24% PABA excretion index). All patients who underwent resection for tumour returned to their preoperative weight.
Kingsnorth
A N
AN
University of Liverpool, Department of Surgery, Royal Liverpool University Hospital.
Berg
J D
JD
Gray
M R
MR
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D000714:Anastomosis, Surgical / Q000379:methods; D004386:Duodenum / Q000601:surgery; D005746:Gastric Emptying / Q000502:physiology*; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D013272:Stomach Diseases / Q000517:prevention & control*; D013997:Time Factors