Preservation of the pylorus and resection of the head of the pancreas |
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Authors: | John W Braasch |
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Affiliation: | (1) Department of Surgery, Lahey Clinic, 41 Mall Road, 01805 Burlington, MA, USA |
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Abstract: | The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections
early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest
in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal
tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure
in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric
emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal
hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective
blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented
of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted
advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase
in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in
value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater. |
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Keywords: | resection pancreas preservation pylorus |
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