Pancreatoduodenectomy with preservation of the pylorus and gastroduodenal artery

Annals of Surgery
H NagaiK Kanazawa

Abstract

The authors evaluated the rationale for and feasibility of gastroduodenal artery preservation in pylorus-preserving pancreatoduodenectomy (PPPD) for periampullary cancer in which the pancreatic remnant maintains a normal function and morphologic characteristics. Pylorus-preserving pancreatoduodenectomy has become one of the standard treatments used for benign and malignant diseases of the pancreatoduodenal region, surpassing ordinary pancreatoduodenectomy in terms of technical ease, mortality rate, and postoperative nutrition. Pylorus-preserving pancreatoduodenectomy is usually associated with gastroduodenal artery division, which presents potential risks of insufficient duodenal vascularity and lethal postoperative bleeding from the gastroduodenal artery stump. The latter complication particularly occurs after resection of bile duct or ampullary cancer in a patient whose pancreas remains functionally and morphologically normal to have much more pancreatic secretion than the fibrotic pancreas seen in pancreatic cancer. According to the authors data on the volume of secretion from the residual pancreas via a stent tube after pancreatoduodenectomy, the sclerotic pancreas, as seen in cancer of the pancreatic head, secrets only 20 ...Continue Reading

References

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Citations

Oct 6, 2006·Langenbeck's Archives of Surgery·Dimitrios LytrasChristos Dervenis
Feb 9, 2011·Langenbeck's Archives of Surgery·Pietro AddeoPatrick Pessaux
Apr 30, 2003·Surgery·Kiyoshi HasegawaMasatoshi Makuuchi
Jan 10, 2014·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Keli M TurnerCherif Boutros
Jan 29, 2008·Journal of the American College of Surgeons·George H SakorafasGeorge Peros
Jul 25, 2013·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·Y ManoN Unno
Sep 23, 2014·International Journal of Surgery Case Reports·Sho OkimotoHideki Ohdan
May 18, 2019·Journal of Hepato-biliary-pancreatic Sciences·Gunjan S Desai, Prasad M Pande

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