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Pylorus-preserving Pancreaticoduodenectomy in the Treatment of Chronic Pancreatitis

World Journal of Surgery volume 27, pages 1211–1216 (2003)Cite this article

Abstract

The pylorus-preserving pancreaticoduodenectomy (PPPD) is an alternative to the standard Whipple resection in the treatment of chronic pancreatitis. The operation is safe and can be performed with a low mortality rate. The most common early complication is delayed gastric emptying, which occurs in 25% to 30% of patients, and generally results in longer hospital stays than the standard Whipple procedure. Follow-up studies show that both operations are equally effective in relieving pain in approximately 75% of selected patients. In the long term, the PPPD successfully preserves physiologic gastric emptying, but at the cost of a higher marginal ulceration rate. The purported nutritional advantages of the PPPD over the classic Whipple resection have not been clearly established. At present, the PPPD is the procedure of choice for patients with chronic pancreatitis requiring panceraticoduodenectomy. Based on available information, this recommendation appears to arise form the fact that the PPPD is less radical than the regular Whipple procedure, and some surgeons find it technically easier. Our experience fails to show a distinct superiority of the PPPD over the Whipple operation.

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References

  1. AO Whipple (1935) ArticleTitleTreatment of carcinoma of the ampulla of Vater Ann. Surg. 102 763–779

    Google Scholar 

  2. IR Trimble JW Parsons CP Sherman (1941) ArticleTitleA one stage operation for the cure of carcinoma of the ampulla of Vater and the head of the pancreas Surg. Gynecol. Obstet. 73 711–722

    Google Scholar 

  3. AO Whipple (1941) ArticleTitleThe rationale for cancer of the pancreas and ampullary region Ann. Surg. 114 612–615

    Google Scholar 

  4. KW Warren MC Veidenheimer HS Pratt (1967) ArticleTitlePancreaticoduodenectomy for periampullary cancer Surg. Clin. North Am. 47 639–345 Occurrence Handle1:STN:280:CCiC3svlsVw%3D Occurrence Handle4290235

    CAS  PubMed  Google Scholar 

  5. K Watson (1944) ArticleTitleCarcinoma of the ampulla of Vater. Successful radical resection Br. J. Surg. 31 368–373

    Google Scholar 

  6. WP Longmire LW Traverso (1981) ArticleTitleThe Whipple procedure and other standard operative approaches to pancreatic cancer Cancer 47 1706–1711 Occurrence Handle6791804

    PubMed  Google Scholar 

  7. LW Traverso WPJ Longmire (1978) ArticleTitlePreservation of the pylorus in pancreaticoduodenectomy Surg. Gynecol. Obstet. 146 959–962 Occurrence Handle1:STN:280:CSeC1c7gt1E%3D Occurrence Handle653575

    CAS  PubMed  Google Scholar 

  8. JW Braasch DJ Deziel RL Rossi et al. (1986) ArticleTitlePyloric and gastric preserving pancreatic resection. Experience with 87 patients Ann. Surg. 204 411–418 Occurrence Handle1:STN:280:BiiD38vnslE%3D Occurrence Handle3767476

    CAS  PubMed  Google Scholar 

  9. CJ Yeo JL Cameron TA Sohn et al. (1997) ArticleTitleSix hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes Ann. Surg. 226 248–257 Occurrence Handle10.1097/00000658-199709000-00004 Occurrence Handle1:STN:280:ByiH2sbosFQ%3D Occurrence Handle9339931

    Article  CAS  PubMed  Google Scholar 

  10. CC Fernandez-Del DW Rattner AL Warshaw (1995) ArticleTitleStandards for pancreatic resection in the 1990s Arch. Surg. 130 295–299 Occurrence Handle7887797

    PubMed  Google Scholar 

  11. SA Barens KD Lillemoe HS Kaufman et al. (1996) ArticleTitlePancreaticoduodenectomy for benign disease Am. J. Surg. 171 131–134 Occurrence Handle10.1016/S0002-9610(99)80087-7 Occurrence Handle1:STN:280:BymC2c3htVQ%3D Occurrence Handle8554127

    Article  CAS  PubMed  Google Scholar 

  12. JW Braasch L Vito FW Nugent (1978) ArticleTitleTotal pancreatectomy of end-stage chronic pancreatitis Ann. Surg. 188 317–322 Occurrence Handle1:STN:280:CSeB2Mrot1U%3D Occurrence Handle686897

    CAS  PubMed  Google Scholar 

  13. MW Buchler H Friess MW Muller et al. (1995) ArticleTitleRandomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis Am. J. Surg. 169 65–69 Occurrence Handle10.1016/S0002-9610(99)80111-1 Occurrence Handle1:STN:280:ByqC3Mjns1c%3D Occurrence Handle7818000

    Article  CAS  PubMed  Google Scholar 

  14. RE Jimenez C Fernandez-del Castillo DW Rattner et al. (2000) ArticleTitleOutcome of pancreaticoduodenectomy with pylorus preservation or with antrectomy in the treatment of chronic pancreatitis Ann. Surg. 231 293–300 Occurrence Handle10.1097/00000658-200003000-00001 Occurrence Handle1:STN:280:DC%2BD3c7nslWjsQ%3D%3D Occurrence Handle10714621

    Article  CAS  PubMed  Google Scholar 

  15. RF Martin RL Rossi KA Leslie (1996) ArticleTitleLong-term results of pylorus-preserving pancreatoduodenectomy for chronic pancreatitis Arch. Surg. 131 247–252 Occurrence Handle1:STN:280:BymC1Mjpt1U%3D Occurrence Handle8611088

    CAS  PubMed  Google Scholar 

  16. MK McAfee JA Heerden Particlevan MA Adson (1989) ArticleTitleIs proximal pancreatoduodenectomy with pyloric preservation superior to total pancreatectomy? Surgery 105 347–351 Occurrence Handle1:STN:280:BiaC283isVI%3D Occurrence Handle2922675

    CAS  PubMed  Google Scholar 

  17. P Morel P Mathey H Corboud et al. (1990) ArticleTitlePylorus-preserving duodenopancreatectomy: long-term complications and comparison with the Whipple procedure World J. Surg. 14 642–646 Occurrence Handle1:STN:280:By6D2cbntFY%3D Occurrence Handle2238666

    CAS  PubMed  Google Scholar 

  18. MW Muller H Friess HG Beger et al. (1997) ArticleTitleGastric emptying following pylorus-preserving Whipple and duodenum- preserving pancreatic head resection in patients with chronic pancreatitis Am. J. Surg. 173 257–263 Occurrence Handle10.1016/S0002-9610(96)00402-3 Occurrence Handle1:STN:280:ByiB1c3ks1M%3D Occurrence Handle9136776

    Article  CAS  PubMed  Google Scholar 

  19. GN Stapleton RC Williamson (1996) ArticleTitleProximal pancreatoduodenectomy for chronic pancreatitis Br. J. Surg. 83 1433–1440 Occurrence Handle1:STN:280:ByiD1MbovFI%3D Occurrence Handle8944465

    CAS  PubMed  Google Scholar 

  20. LW Traverso RA Kozarek (1997) ArticleTitlePancreatoduodenectomy for chronic pancreatitis: anatomic selection criteria and subsequent long-term outcome analysis Ann. Surg. 226 429–435 Occurrence Handle10.1097/00000658-199710000-00004 Occurrence Handle1:STN:280:DyaK1c%2Fht1SktA%3D%3D Occurrence Handle9351711

    Article  CAS  PubMed  Google Scholar 

  21. AL Warshaw PA Banks CC Fernandez-Del (1998) ArticleTitleAGA technical review: treatment of pain in chronic pancreatitis Gastroenterology 115 765–776 Occurrence Handle1:STN:280:DyaK1czoslymtA%3D%3D Occurrence Handle9721175

    CAS  PubMed  Google Scholar 

  22. PA Grace HA Pitt WP Longmire (1986) ArticleTitlePancreatoduodenectomy with pylorus preservation for adenocarcinoma of the head of the pancreas Br. J. Surg. 73 647–650 Occurrence Handle1:STN:280:BimB1MjktVU%3D Occurrence Handle3742181

    CAS  PubMed  Google Scholar 

  23. A Desjardins (1907) ArticleTitleTechnique de la pancreatectomie Rev. Chir. 35 945–973

    Google Scholar 

  24. AL Warshaw DL Torchiana (1985) ArticleTitleDelayed gastric emptying after pylorus-preserving pancreaticoduodenectomy Surg. Gynecol. Obstet. 160 1–4 Occurrence Handle1:STN:280:BiqD28nivFM%3D Occurrence Handle3964962

    CAS  PubMed  Google Scholar 

  25. DW Crist JV Sitzmann JL Cameron (1987) ArticleTitleImproved hospital morbidity, mortality, and survival after the Whipple procedure Ann. Surg. 206 358–365 Occurrence Handle1:STN:280:BiiA38rhslU%3D Occurrence Handle3632096

    CAS  PubMed  Google Scholar 

  26. LW Traverso WPJ Longmire (1980) ArticleTitlePreservation of the pylorus in pancreaticoduodenectomy a follow-up evaluation Ann. Surg. 192 306–310 Occurrence Handle1:STN:280:Bi6D38%2Fis1Q%3D Occurrence Handle7416828

    CAS  PubMed  Google Scholar 

  27. AS Fink LR DeSouza EA Mayer et al. (1988) ArticleTitleLong-term evaluation of pylorus preservation during pancreaticoduodenectomy World J. Surg. 12 663–670 Occurrence Handle1:STN:280:BiaB38vktVI%3D Occurrence Handle3245219

    CAS  PubMed  Google Scholar 

  28. W Kozuschek HB Reith H Waleczek et al. (1994) ArticleTitleA comparison of long term results of the standard Whipple procedure and the pylorus preserving pancreatoduodenectomy J. Am. Coll. Surg. 178 443–453 Occurrence Handle1:STN:280:ByuB387jtlU%3D Occurrence Handle7909485

    CAS  PubMed  Google Scholar 

  29. RS McLeod BR Taylor BI O’Connor et al. (1995) ArticleTitleQuality of life, nutritional status, and gastrointestinal hormone profile following the Whipple procedure Am. J. Surg. 169 179–185 Occurrence Handle10.1016/S0002-9610(99)80129-9 Occurrence Handle1:STN:280:ByqC3MjnsFY%3D Occurrence Handle7817989

    Article  CAS  PubMed  Google Scholar 

  30. JE Doty JH Meyer (1988) ArticleTitleVagotomy and antrectomy impairs canine fat absorption from solid but not liquid dietary sources Gastroenterology 94 50–56 Occurrence Handle1:STN:280:BieD1cvisV0%3D Occurrence Handle3335297

    CAS  PubMed  Google Scholar 

  31. M Hongo K Satake K Sanoyama et al. (1987) ArticleTitleRegulation of insulin demand by gastric emptying in diabetics Gastroenterology 92 1374

    Google Scholar 

  32. CF Frey HA Pitt RA Prinz (1996) ArticleTitleA plea for uniform reporting of patient outcome in chronic pancreatitis Arch. Surg. 131 233–234 Occurrence Handle1:STN:280:BymC1MjptFw%3D Occurrence Handle8611085

    CAS  PubMed  Google Scholar 

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Affiliations

  1. Department of Surgery, Hartford Hospital, University of Connecticut School of Medicine, 80 Seymour Street, P. O. Box 5037, Hartford, Connecticut 06102, USA

    Ramon E. Jimenez M.D.

  2. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WHT506, Boston, Massachusetts 02114-2696, USA

    Carlos Fernandez-del Castillo M.D., David W. Rattner M.D. & Andrew L. Warshaw M.D.

Authors
  1. Ramon E. Jimenez M.D.
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  2. Carlos Fernandez-del Castillo M.D.
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  3. David W. Rattner M.D.
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  4. Andrew L. Warshaw M.D.
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Correspondence to Andrew L. Warshaw M.D..

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Jimenez, R., Fernandez-del Castillo, C., Rattner, D. et al. Pylorus-preserving Pancreaticoduodenectomy in the Treatment of Chronic Pancreatitis. World J. Surg. 27, 1211–1216 (2003). https://doi.org/10.1007/s00268-003-7240-0

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  • DOI: https://doi.org/10.1007/s00268-003-7240-0

Keywords

  • Chronic Pancreatitis
  • Gastric Emptying
  • Pancreatic Duct
  • Superior Mesenteric Vein
  • Delay Gastric Emptying