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KMID : 0378019820250070066
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New Medical Journal
1982 Volume.25 No. 7 p.66 ~ p.74
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The Significance of Pylorus Preservation in Pancreaticoduodenectomy
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Abstract
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Since Whipple(1941) had introduced the pancreaticeduodenectomy, distal gastrectomy with removal of pylorus is one of the essential procedures in surgery of periampullary malignant lesions.
The complete resection of antrum and pylorus had sequentially resulted in severe weight loss, steatorrhea and malnutrition postoperatively due to alteraticn of gastric function.
Recently, the surgical procedure with preservation of antrum and pylorus in pancreaticoduodenectomy was begun to be applied clinically in patient to prevent nutritional complications (Traverso & Longmire, 1978).
This experiments were carried out in mongrel dogs to detect the significance of antrum and pylorus preservation on gastric emptying time, gastric acid out put and to observe the histopathological changes of gastricmucosa after pancreaticoduodenectomy.
The animals were divided into three groups; normal control, pylorus preserving pancreaticoduodenectomy and Whipple´s operation group.
The functional changes of stomach after operation were assessed by postoperative weight change at the interval of two weeks, gastric emptying time with liquid and solid meals in the postoperative twelfth week and output of basal and pentagastrin stimulation of gastric acid in postoperative eight to ten weeks.
The results obtained were as follows:
1. During the whole observation period, pylorus preserving pancreaticoduodenectomy and Whipple´s operation group showed marked weight loss compared with normal control group but weight loss in pylorus preserving pancreaticoduodenectomy group was less severe than Whipple´s operation group.
2. The liquid and solid, emptying times (55±17, 272±73min) in pylorus preserving pancreaticoduodenectomy group showed no statistical differences compared with normal control group (48±15, 258±59min) (P>0.1) but Whipple´s operation group (37±13, .93±29min) showed shorter emptying time than normal control and pylorus preserving pancreaticcducdenectomy group (P<0.05).
3. There was no statistical differene in basal acid output (BAO) among pylorus preserving pancreaticoduodenectomy (0.56±0.4lmEq/hr), Whipple´s operation (0.41±0.38mEq/hr).- and normal control (0.45±0.33mEq/hr) group (P>O.1).
But pentagastrin stimulation of maximum acid output (MAO) (19.45±2.18mEq/hr) in Whipple´s operation group was markedly reduced compared with normal control group (28. 40±2.64mEq/hr) (P<0.05).
MAO (29.40±2. 16mEq/hr) in pylorus preserving pancreaticoduodenectomy group showed no statistical difference compared with normal control group (PCO. 1).
4. The histopathological changes of the gastric mucosa in Whipple´s operation group were more marked than pylorus preserving pancreaticoduodenectomy group.
With those experiments, the surgical procedure of antrum and pylorus preservation in pancreaticoduodenectomy demonstrated better gastric emptying of solid meal without significant changes of gastric acidity and gastric mucosa.
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