title: Modified pancreaticoduodenectomy: experience with 81 cases, Wahab modification.
abstract: OBJECTIVE
  Now pancreaticoduodenectomy is considered a safe and acceptable line of treatment for periampullary tumors. In spite of improvements in the surgical technique it still has a high morbidity rate. In this study we introduce new technical modifications for the original procedure aiming to decrease the incidence of morbidity.
  
  
  METHODS
  Between 1994-2000, 210 pancreaticoduodenectomies were done in the Gastroenterology Center, Mansoura University, Egypt for periampullary tumor. Eighty-one of these patients were subjected to modified pancreaticoduodenectomy. They were 57 men and 34 women with a mean age of 54 (+/- 8) years. Pancreatic carcinoma represented 54%, ampullary tumor 30%, bile duct carcinoma 5% and duodenal carcinoma 1.2%. The mean operative time was 3.7 +/- 0.5 hours and mean estimated blood loss during surgery was 733 +/- 48 mL.
  
  
  RESULTS
  Hospital mortality occurred in 3.7% with an overall morbidity rate of 32%. The most common complications were delayed gastric emptying 8.9%, pancreatic fistulae 3.8%, wound infection 6.4%, biliary leakage 3.8% and bleeding 5%. The mean postoperative hospital stay was 9.4 +/- 1 days, with mean time for starting oral feeding 6 +/- 0.9 days. Late mortality occurred in 46% for the entire group with mean follow-up 22 +/- 19 months with actuarial survival for 1, 2, 3, 4, and 5 years being 80, 45, 25, 15, and 10%, respectively.
  
  
  CONCLUSIONS
  It was found that this new modification made the operation easier with shorter operative time, less blood transfusion, low incidence of morbidity and short hospital stay. Moreover, it takes the advantages of lowering the incidence of biliary gastritis, cholangitis and peptic ulcer.
authors.affiliation: Gastroenterology Center, Mansoura University, Mansoura, Egypt. Wahabmeg@yahoo.com
authors.forename: M
authors.initials: M
authors.lastname: Abdel-Wahab
authors.forename: A
authors.initials: A
authors.lastname: Sultan
authors.forename: N
authors.initials: N
authors.lastname: elGwalby
authors.forename: O
authors.initials: O
authors.lastname: Fathy
authors.forename: A
authors.initials: A
authors.lastname: AboElenen
authors.forename: M A
authors.initials: MA
authors.lastname: Zied
authors.forename: A
authors.initials: A
authors.lastname: Fouad
authors.forename: T A
authors.initials: TA
authors.lastname: Allah
authors.forename: G
authors.initials: G
authors.lastname: el-Ebiedy
authors.forename: N
authors.initials: N
authors.lastname: Gad-ElHak
authors.forename: A
authors.initials: A
authors.lastname: Elfiky
authors.forename: F
authors.initials: F
authors.lastname: Ezzat
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies