Marginal ulceration after pylorus-preserving pancreaticoduodenectomy.
Marginal ulceration is a serious problem after both standard pancreaticoduodenectomy (PD) and pylorus-preserving pancreaticoduodenectomy (PPPD). The relationship between this complication and the method of reconstruction after PPPD was analyzed in this study. Patients who underwent standard PD (n = 72) or PPPD (n = 28) in the 20-year period from 1978 to 1997 were retrospectively reviewed. After PPPD, 4 patients (14.3%) developed marginal ulceration on the jejunal side of the duodenojejunal anastomosis, while none of the patients had marginal ulceration after standard PD. The marginal ulcer occurred in 3 of 14 patients treated with the Roux-en-Y method, and in 1 of 9 treated with pancreatogastrostomy. In the Roux-en-Y method, the anal jejunal loop anastomosed to the bulb was directly exposed to gastric juice without neutralization by pancreatic juice from the oral jejunal limb. Of the 4 patients with marginal ulceration, 2 of those treated by the Roux-en-Y method required gastrectomy; the other 2 patients were treated medically. Our analysis of the literature showed that the Roux-en-Y method had the highest incidence of marginal ulcerations. The gastrointestinal reconstruction method without a mixture of gastric juice and pancreatic juice may be a causal factor in the marginal ulceration that occurs after PPPD. In reconstruction after PPPD, we should not create a jejunal loop that is exposed to gastric juice alone.
Sakaguchi
T
T
Department of Surgery II, Hamamatsu University School of Medicine, 3600 Handa-cho, Hamamatsu 431-3192, Japan.
Nakamura
S
S
Suzuki
S
S
Kojima
Y
Y
Tsuchiya
Y
Y
Konno
H
H
Nakaoka
J
J
Nishiyama
R
R
D000368:Aged; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D002908:Chronic Disease; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D010195:Pancreatitis / Q000601:surgery; D011379:Prognosis; D011708:Pylorus; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D013276:Stomach Ulcer / Q000209:etiology* / Q000473:pathology / Q000628:therapy
D000897:Anti-Ulcer Agents