Pylorus preserving pancreaticoduodenectomy.

We have performed 9 pylorus preserving pancreaticoduodenectomies (PPPD) for periampullary malignancies. In these 9 patients, six had been diagnosed as having carcinoma of the ampulla of Vater, two pancreatic carcinoma and one duodenal carcinoma. We have no operative mortality and a 44 per cent rate of morbidity. Complications include wound infections (3), pleural effusion (1), intraabdominal abscess (1), delayed gastric emptying (1). There was neither biliary nor pancreatic leakage in these patients. None of the patients had gastrointestinal haemorrhage and marginal ulceration. We have complete follow-up for all cases. Eight of 9 patients are alive, one patient who had been operated for carcinoma of ampulla of Vater died the 14th month postoperatively. During the follow-up, in 7 patients we have observed neither recurrence nor metastasis but in one patient, who is still alive, operated for carcinoma of the pancreas, recurrence in the pancreatic remnant was detected 27 months after the operation. In four months, all patients regained 90 per cent of the weight lost prior to operation. During the follow-up period no patients had gastrointestinal dumping, diarrhoea, or delayed gastric emptying. We concluded that PPPD, technically easier and faster, can therefore be performed with a much lower morbidity and mortality than the standard Whipple procedure. Preservation of the pylorus reduces the incidence of marginal ulceration, and patients undergoing PPPD are more likely to regain their preoperative weight. The antrum and pylorus were structurally preserved in the first successful radical pancreaticoduodenectomy performed by Kausch in 1912 (13) and Whipple in 1935 (28).(ABSTRACT TRUNCATED AT 250 WORDS)