Current Opinion on Preservation of the Pylorous in Pancreato-Duodenectomy

Abstract

Pyloric preservation as modification to standard Whipple procedure was introduced to prevent the complications of gastrectomy ensuring better gastrointestinal function. It was initially established as the operation of choice for chronic pancreatitis but remained debatable in case of malignancy, since adenocarcinoma of the pancreas has dismal prognosis and radical resection is the only chance for cure. A PubMed search of relevant articles published up to day was performed to identify current information about pylorous preserving pancreatoduodenectomy especially its outcome regarding radicality and delayed gastric emptying. Pancreatoduodenectomy with pyloric preservation deals with better functional and nutritional outcome. It exhibits similar oncological efficacy with standard Whipple operation for the treatment of cancer of the pancreatic head and the periampullary area; it is considered as the procedure of choice in most of the cases. Delayed gastric emptying is not exclusively associated with pyloric preservation. The antecolic placement of the duodenojejunal anastomosis together with respect to the neurovascular integrity during dissection could contribute to prevention of this complication. The preservation of the stomach by resection only the pyloric ring has been proposed as a new approach. The preservation of the pylorus has already been consecrated for both benign and malignant disease with satisfactory short and long term results.




doi:10.4021/jcs35w