Long‐term evaluation of pylorus preservation during pancreaticoduodenectomy

Although pyloric preservation can be performed during pancreaticoduodenectomy without increased morbidity or mortality or decreased survival, the long‐term benefit of this technique remains unproven. In this study, the functional status of patients recovered from pyloric‐preserving pancreaticoduodenectomy was evaluated by comparing 6 long‐term survivors of the standard Whipple procedure (1–7 years postoperative; mean, 4.7 yr) to a similar group of 6 patients recovered from pylorus preservation pancreaticoduodenectomy (1–7 years postoperative; mean, 3.0 yr). All patients completed a questionnaire evaluating postgastrectomy symptoms. Fasting blood specimens were obtained for hematologic and biochemical analysis. Ten of the 12 patients then underwent endoscopy; perianastomotic and midgastric biopsies were graded for inflammation. Gastric emptying of both liquid and solid phases was measured with an isotopically‐labeled meal. Gastric emptying data were compared between groups and also to a group of 7 normal controls studied previously using the same methodology. Analysis of questionnaire results and mean laboratory values revealed no significant differences between the 2 surgical groups. Serum carotene levels were low in most patients. Several patients demonstrated abnormal indices of iron homeostasis. No significant abnormalities were noted on endoscopic examinations and biopsy results did not differ between the 2 surgical groups. Liquid gastric emptying was significantly prolonged in patients following standard pancreaticoduodenectomy (t1/2=98.3±26.2 min) as compared to pylorus preservation patients (t1/2=37.5±10.9 min) or normal controls (t1/2=33.1±2.8 min). We conclude that, in the long‐term, pylorus preservation appears to be at least functionally equivalent to the standard pancreaticoduodenectomy. As such, we believe that pyloric preservation, obviating vagotomy and gastric resection, deserves consideration during pancreaticoduodenectomy. Résumé La conservation du pylore dans la duodénopancréatectomie céphalique n'augmente pas la morbidité ou la mortalité opératoire, et ne diminue pas la survie à distance. Cependant les bénéfices à long terme de cette conservation restent inconnus. Dans cette étude, on a comparé l'état fonctionnel de 6 patients ayant survécu après l'opération de Whipple (survie moyenne, 4.7 ans; extrêmes, 1 et 7 ans) à celui de 6 autres patients ayant subi une duodénopancréatectomie céphalique avec conservation du pylore (moyenne, 3.0 an