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Pylorus‐Preserving pancreaticoduodenectomy for pancreatic and peripancreatic malignancies: A 1996 perspective
Author(s) -
Frey Charles F.
Publication year - 1997
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/bf02489786
Subject(s) - pancreaticoduodenectomy , medicine , anastomosis , pylorus , billroth i , duodenal bulb , billroth ii , general surgery , pancreatic cancer , surgery , gastroenterology , duodenum , stomach , pancreas , gastrectomy , cancer
Pylorus‐preserving pancreaticoduodenectomy, based on review of the literature, conveys little, if any, measurable benefit over the standard operation with regard to nutrition and metabolism. Some of the benefits attributed to pylorus preservation by Traverso may be due instead to his use of a duct‐to‐mucosa pancreaticojejunostomy anastomosis which preserves pancreatic function. Comparisons of the standard and pylorus‐preserving operation in regard to metabolic, nutritional, and postgstrectomy syndromes are hindered by a lack of uniformity from one report to another regarding the type of pancreaticojejunostomy anastomosis performed, the amount of stomach resected, whether vagotomy was or was not performed, and whether a Billroth I or II gastrojejunostomy or duodenojejunostomy was performed. Pylorus‐preserving pancreaticoduodenectomy can be used safely in the management of about 85% of patients with pancreatic and distal common bile duct cancer and in 95% of those with ampullary cancer. The standard operation should be used in the presence of any sign of tumor infiltration of the duodenal bulb or peripyloric lymph nodes. Japanese surgeons have emphasized the utility of employing the Billroth I rather than Billroth II anastomosis after pancreaticoduodenectomy, as it provides access to visualize endoscopically the pancreaticojejunostomy and choledochojejunostomy anastomosis.