Pylorus-preserving proximal pancreatico-duodenectomy the U.H.W.I. experience of the pylorus-sparing whipple's procedure - abstract

ABSTRACT

The modified Whipple gastro-pancreatico-duodenectomy has been the time-honoured surgical management of duodeno-pancreatic disease for the past five decades. A pylorus-sparing modification of this operation has become popular due to its low morbidity and the relative lack of the long-term nutritional sequelae usually associated with the more radical procedure. We report five cases with a proximal pancreatico-duodenectomy in whom the stomach, pylorus abd first 2 cm of duodenum were preserved. The indcations for the procedure were varied and included duodeno-pancreatic haemangioma (1), duodeno-pancreato-codochal trauma (1), chronic pancreatitis (1), papillary cystic tumour of the pancreas (1), and ampullary adenocarcinoma (1). All cases had gastrostomy decompression and post-operative enteral nutrition. Two patients required enteral feeding for twelve days, the other three settled rapidly and were discharged from hospital within ten days. There were no perioperative deaths or significant long-term morbidity. Most patients regained and maintained their pre-illness body weight within the first year of follow-up. We advocate the use of a pylorus-sparing pancreatico-duodenectomy in disease requiring duodeno-pancreatectomy inclusive of periampullary malignancies (AU)