Preservation of the pyloric ring confers little benefit in patients undergoing total pancreatectomy.
BACKGROUND
The clinical significance of preservation of the pyloric ring in total pancreatectomy (TP) has not been elucidated.


METHODS
A total of 48 consecutive patients underwent TP and were categorized into two groups based on the absence or presence of pylorus resection: the TP (N = 33) and pylorus-preserving TP (PPTP) (N = 15) groups. Preoperative patient background, intraoperative conditions, postoperative complications, and long-term nutritional status were retrospectively compared between the two groups.


RESULTS
Patient background was similar between the groups, with the exception of the prevalence of preoperative diabetes mellitus (55 and 20 %, respectively; p = 0.021). There were no differences between groups with respect to operative times, blood loss, or blood transfusion. The PPTP group was more likely to have postoperative delayed gastric emptying than was the TP group (53 and 21 %, respectively; p = 0.029), and it tended to become increasingly severe. The length of the postoperative fasting period was significantly longer in the PPTP group than in the TP group (mean 15 ± standard deviation [SD] 10.8 and 9 ± 9.7 days, respectively; p = 0.023). The body weights in the TP group started to recover by 1 year postoperatively, whereas those in the PPTP group continued to decrease. Serum hemoglobin levels tended to be higher in the TP group than in the PPTP group at 1 year postoperatively.


CONCLUSIONS
Preservation of the pyloric ring provided little or no benefit to short-term outcome or long-term nutritional status among patients who underwent TP.
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Hideki
H
Takami
Tsutomu
T
Fujii
Mitsuro
M
Kanda
Masaya
M
Suenaga
Kazuo
K
Yamamura
Yasuhiro
Y
Kodera
D000368:Aged; D005215:Fasting; D005260:Female; D005746:Gastric Emptying; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D059351:Organ Sparing Treatments / Q000009:adverse effects; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors
D006454:Hemoglobins