[Antral exclusion. A complement to palliative gastrojejunal shunt in pancreatic cancer].

OBJECTIVES

Prophylactic gastrojejunostomy remains a controversial issue in the management of unresectable pancreatic cancer. The main disadvantage of the gastrojejunostomy being the postoperative delayed gastric emptying (gastroparesia and circulus vitiosus through the nonobstructed duodenum). In the aim to reduce the effects of delayed gastric emptying we advocated the adjunct of an antral exclusion to simplify antrectomy by eliminating antral dysfunction and duodenal circulus vitiosus.

METHODS

The procedure of antral exclusion was performed using a 4-row linear stapler. The gastrojejunostomy was immediately proximal to the staples row.

RESULTS

Preliminary results in 6 patients, evaluated by clinical follow up, radiologic and radionucleide studies, showed no delayed gastric emptying nor other postoperative complications related to this technique.

CONCLUSION

These preliminary results are encouraging and suggest that this procedure could improve the functional results of the prophylactic gastrojejunostomy.