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Stomach-Preserving Pancreaticoduodenectomy

  • Min Wang
  • Ren-Yi QinEmail author
Chapter

Abstract

Whipple first reported pancreaticoduodenectomy with resection of the distal stomach in 1941 [1]. Soon afterwards, the first pylorus-preserving pancreaticoduodenectomy (PPPD) (Fig. 5.1) was performed in 1944 [2]. Classic Whipple’s and PPPD are now the most widely used surgical procedures for pancreatic head and periampullary tumors [3]. Whereas the classic Whipple’s procedure includes resection of the pancreatic head, duodenum, gallbladder, distal common bile duct, partial jejunum, and distal stomach, in PPPD, the proximal duodenum is transected 3–4 cm distal to the pyloric ring [3]. Delayed gastric emptying (DGE) is one of the most common postoperative complications following PD. The mechanisms underlying DGE remain unclear but may result from the extent of gastric resection, loss of the pylorus, interrupted gastrointestinal neural connections, diabetes, local ischemia, or loss of gastrointestinal hormonal production causing gastroparesis [4]. DGE after PPPD has been attributed to devascularization and denervation of the pylorus with subsequent pylorospasm. Although DGE is not life-threatening, it leads to prolonged hospital stays, which increases hospital costs and decreases patients’ quality of life. Decreasing the occurrence of DGE is important in patients undergoing any type of PD [5].

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Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina

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