PYLORIC FUNCTION AFTER PYLORUS-PRESERVING PANCREATODUODENECTOMY

Document Type : Original Article

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Department of Surgery, Faculty of Medicine, Cairo University

Abstract

This work compares the outcome of pylorus preserving pancreatoduodenectomy (PPPD) for periampullary carcinoma
after 2 reconstructive methods, Billroth-I (B-I) and Billroth-II (B-II). A special consideration was given to pyloric function
after PPPD (gastric emptying and pyloric sphincter competence) as it has been frequently reported to be disturbed after the procedure. Of the studied 26 patients, 15 patients had the classical B-II reconstruction while 11 patients had B-I
reconstruction. Patients were comparable for age and sex in both groups. Mortality was 11.5% and complications occurred in 38.5% of cases. Delayed gastric emptying (DGE) occurred in 69.9% of cases in the immediate postoperative phase. At followup, 69.5% of patients had GI symptoms and 30.4% of patients had DGE. Bile stasis was observed in 4 patients (17.4%) and biliogastric reflux in 3 of them (13%). Antral gastritis occurred in 3 patients (13%) and reflux esophagitis in one patient (4.3%). Mortality and morbidity showed no significant difference between the 2 groups. In the early phase, the incidence of DGE was comparable in both groups but delayed food tolerance was more observed in group B-II. In the late phase, the delay in gastric emptying in B-II patients involved the actual emptying phase rather than the lag period, suggesting dysfunction of proximal jejunal loop as an explanation for the delay. Biliogastric reflux, antral gastritis and reflux esophagitis were all limited to group B-II patients. In conclusion, both methods of reconstruction are comparable as regards general outcome but B-I reconstruction is probably superior functionally.

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