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KMID : 0371319960500050683
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Journal of the Korean Surgical Society
1996 Volume.50 No. 5 p.683 ~ p.690
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Preserving Supra-, Retro- and Gastroduodenal Arteries to Prevent Gastric Stasis after Pylorus- Preserving Pancreatoduodenectomy
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Abstract
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Gastric stasis during early postoperative period was developed in a certain portion of patients after pylorus-preserving pancreatoduodenectomy(PPPD). The suggested causes are vascular, neural, or motor-complex origin and surrounding local area
complications causing paralysis. Therefore preservation of the right gastric artery with vagal branch or enough length of duodenal bulb has been recommended to prevent gastric stasis. However, in some patients, circulation of the duodenal bulb is
poor
and stasis occurs despite preserving the above structures.
We tried to maximize the blood supply to the duodenal bulb by preserving various duodenal arteries to prevent early postoperative gastric stasis after PPPD. The early postoperative cutcome was compared with that of PPPD before this trial to find
the
effect of vascular preservation on gatric stasis.
During PPPD for nonpancreatic periampullary carcinomas, the supraduodenal artery and retroduodenal artery with the short segment of gastroduodenal artery as well as right gastric artery are preserved. In cases with rudimentary or transected right
gastric artery, the right gastroepiploic artery with gastroduodenal artery dissected out from pancreatic head is preserved. We applied this principle to 7 cases of PPPD and we did not experienced any case with gastric stasis, defined as
nasogastric
drainage necessary 10 days or longer.
Maximizing blood supply to the lst of the duodenum by preserving supra-, retro- and/or gastroduodenal arteries possibly prevent early postoperative gastric stasis after PPPD, at least in a certain portion of patients, in whom the cause of stasis
is
vascular insufficiency to the duodenal bulb.
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