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At least 235 records · Page 13Linked to original sources
PubMed2005

Gastric cancer developing in the stomach after pylorus-preserving pancreaticoduodenectomy with pancreaticogastrostomy: case report and review of the literature.

A 59-year-old woman underwent surgery for uterine corpus cancer in March 1998. She also underwent pylorus-preserving pancreaticoduodenectomy with pancreaticogastrostomy for common bile duct cancer in November 1998. She was followed up at our outpatient clinic after pylorus-preserving pancreaticoduodenectomy. In November 2002, her carcinoembryonic antigen level became elevated and abdominal ultrasound revealed a huge tumor. Gastroscopy showed a Borrmann type 3 tumor at the anastomosis of the pancreaticogastrostomy, and a biopsy revealed adenocarcinoma. With a diagnosis of advanced gastric cancer, she underwent total gastrectomy, splenectomy, and residual pancreatectomy in January 2003. The pathologic findings revealed that the gastric cancer was separated from the pancreas, suggesting that the cancer had developed from the stomach. The present report describes a rare case of gastric cancer that had developed at the anastomosis of a pancreaticogastrostomy.

Adenocarcinoma↗
PubMed1995

Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis.

BACKGROUND: In about 30% of patients, chronic pancreatitis leads to an inflammatory enlargement of the pancreatic head with subsequent obstruction of the pancreatic duct, common bile duct, and duodenum. METHODS: In a prospective, randomized controlled trial, we compared duodenum-preserving pancreatic head resection (DPPHR) with pylorus-preserving Whipple (PPW) operation to define the advantages of each operation with regard to (1) postoperative complications, (2) glucose tolerance and induction of diabetes mellitus, and (3) postoperative pain and quality of life up to 6 months after operation for chronic pancreatitis. RESULTS: The two study groups of 20 patients were both well balanced with regard to sex, age, history of chronic pancreatitis, and indication for surgery. Postoperative mortality was zero. After duodenum-preserving and pylorus-preserving resection, morbidity was 15% and 20%, respectively. After 6 months, patients who underwent the duodenum-preserving resection had less pain, greater weight gain, a better glucose tolerance, and a higher insulin secretion capacity. CONCLUSION: The DPPHR compares favorably with the standard PPW operation and should be considered as an alternative procedure in the treatment of chronic pancreatitis.

Adult↗
PubMed1996

The ontogeny of the peptide innervation of the human pylorus, with special reference to understanding the aetiology and pathogenesis of infantile hypertrophic pyloric stenosis.

Pyloric stenosis (PS) is a common condition in infancy, which is associated with smooth muscle hypertrophy that results in pyloric outlet obstruction. The author examines the ontogeny of the peptide innervation of the pylorus in fetal tissues and an experimental model in mice and evaluates the histochemical and morphological changes in the pylorus. The data suggest that PS is an intrauterine lesion that occurs by 12 weeks' gestation. This is associated with diminished nitric oxide in human tissues and reduced enzyme activity (resulting from a deficiency in an enzyme cofactor) in mice. Increased vasoactive intestinal polypeptide expression in pyloric myenteric ganglia may be an intrinsic mechanism for resolving this condition.

Animals↗
PubMedDate not supplied

Cholecystectomy, liver resection, and pylorus-preserving pancreaticoduodenectomy for gallbladder cancer: report of five cases.

Carcinoma of the gallbladder is an uncommon yet highly malignant disease with a poor overall prognosis. Surgical resection offers the only hope for cure in patients with this type of cancer, but resection is often impossible because of advanced disease at the time of presentation. Patients with locally advanced gallbladder cancer, however, may occasionally be amenable to management by adding pancreaticoduodenectomy to cholecystectomy and liver resection. A retrospective review of patient records at the Johns Hopkins Hospital identified five patients with gallbladder cancer with peripancreatic lymph node involvement, who were treated by surgical resection including pancreaticoduodenectomy. The preoperative evaluation, operative technique, pathologic findings, and outcome were reviewed for each patient. Follow-up was obtained via clinic visit or telephone contact. All five patients underwent resection of the gallbladder cancer with an operation that included pylorus-preserving pancreaticoduodenectomy to remove the peripancreatic lymph nodes. In addition, four of the five patients underwent a nonanatomic liver resection. There were no in-hospital deaths. Two patients had postoperative complications; one had persistent drainage from a T-tube site and one had an anastomotic leak from the hepaticojejunostomy. Four patients have died of recurrent tumor during follow-up at intervals ranging from 11 months to 23 months. The fifth patient is alive and free of clinical disease at 42 months after operation. Carcinoma of the gallbladder is a highly malignant disease that is often not amenable to surgical cure. There is a select group of patients, however, in whom adding a pylorus-preserving pancreaticoduodenectomy can result in a potentially curative operation by removing extensive regional spread to the peripancreatic lymph nodes.

Adenocarcinoma↗
PubMed2000

Long-term postoperative functional evaluation of pylorus preservation in Imanaga pancreatoduodenectomy.

Our purpose was to determine whether pylorus-preservation in the Imanaga (PpPDI) method minimizes postoperative impairment of gastrointestinal function. Nine patients who had undergone PpPDI (postoperative years: 5.7 +/- 2.6) and nine patients who had undergone conventional Imanaga pancreatoduodenectomy (PDI) (postoperative years: 6.8 +/- 2.0) were evaluated for symptoms, nutritional parameters, and physiologic function of the biliary tract and residual stomach using gastric emptying and hepatobiliary scintigraphy. The body weight recovered to 99.3% +/- 3.8% of pre-illness body weight in PpPDI, showing a significantly better recovery than in patients after the PDI procedure (91.0% +/- 6.4%, P < 0.05). The mean gastric emptying half-time (GET1/2) in the upright position after PDI was significantly shorter (42.3 min) than after PpPDI (80.8 min, P < 0.05). Mixture of food with bile was conserved better in the PpPDI group than in the PDI group. In the long term, the pylorus-preserving Imanaga-type procedure minimizes disruption of gastric function and asynchrony between ingested food and bile.

Adult↗
PubMed2002

Effect of gastrointestinal reconstruction on quality of life and nutritional status after pylorus-preserving pancreatoduodenectomy.

A total of 31 Japanese patients who underwent pylorus-preserving pancreatoduodenectomy from January 1998 through September 2000 were studied regarding quality of life and nutritional status before and within two months (short term) and six months to one year (long term) after surgery. Quality of life was estimated using a questionnaire consisting of 23 items (13 physical and 10 psychosocial domains). Nutritional status was assessed by body weight, hemoglobin concentration, serum concentration of albumin and cholesterol, and pancreatic function. These data were compared between 18 patients with end-to-end (Imanaga) and 13 with end-to-side (Traverso) gastrointestinal reconstruction. In both groups, physical quality of life scores dropped at short term, and then returned to the normal level at long term after operation, showing mostly parallel changes with the parameters of nutritional status. However, the scores of psychosocial conditions, which reflected the patient's mental health, remained low even at long term in both groups. The values of these parameters showed no statistical difference between the two groups at each time point. Postoperative quality of life and nutritional status were not different between Imanaga and Traverso reconstructions after pylorus-preserving pancreatoduodenectomy and mental health care would be necessary for at least one year after operation in both groups.

Adult↗
PubMed1989

Pylorus-preserving Whipple pancreaticoduodenectomy: postoperative evaluation.

The pylorus-preserving Whipple pancreaticoduodenectomy is becoming a popular alternative to the standard Whipple operation. Fluoroscopy plays an important role in postoperative assessment. The authors evaluated images of 50 consecutive patients who had undergone the newer procedure. Thirty-one complications were identified. Two normal variants that could be confused with abnormalities were noted: (a) the featureless appearance of the duodenal bulb may be mistaken for extravasation, and (b) contrastmaterial filling of the proximal jejunal loop at an end-to-end anastomosis with retained invaginated pancreas may be mistaken for intussusception. Another pitfall was failure to evaluate the pancreaticojejunostomy anastomosis fully, resulting in false-negative radiologic interpretations when leaks were present. The approach to postoperative examination of patients who have undergone the pylorus-preserving Whipple procedure is different from that of patients who have undergone the standard procedure. Radiologists should be familiar with this approach, the normal postoperative anatomy, and pitfalls in imaging so that complications can be diagnosed and treated.

Adult↗
PubMed1999

Gastroduodenal ulcer treated by pylorus and pyloric vagus-preserving gastrectomy.

AIM:To evaluate the curative effect of pylorus and pyloric vagus-preserving gastrectomy (PPVPG) on peptic ulcer.METHODS:Treating 132 cases of GU and DU with PPVPG, and comparative studies made with 24 cases treated with Billroth II (B II ) and 20 cases with Billroth I(BI); advantages and shortcomings evaluated.RESULTS:Not a single death after PPVPG. No recurrence of the disorder in the subsequent follow-up for an average of 6.5 years. Curative effect (visik II & I) 97.7%. Acidity reduction similar to that found in B II and BI, but 97.7% of the B II and all BIcases having more than second degree intestinal fluid reflux, in contrast to 7.1% in PPVPG cases. Dumping syndrome occurred in the B II and BI cases, none in PPVPG cases. With regard to gastric emptying, food digestion, absorption, body weight and life quality, PPVPG proved to be superior to Billroth procedure.CONCLUSION:PPVPG has the advantages of conventional Billroth gastrectomy in reducing acid, removing ulcer focus, and at the same time preserves the pylorus and pyloric vagus for maintaining the normal gastric physiological function.Dumping syndrome,intestinal fluid reflux and other complications of conventional gastrectomy may be avoided.

Journal Article↗
PubMedDate not supplied

Fat absorption after pylorus-preserving pancreatoduodenectomy reconstructed with Billroth II pancreaticojejunostomy or Billroth I pancreaticogastrostomy.

BACKGROUND/AIMS: The aim of this study was to determine whether Billroth I pancreaticogastrostomy (PG-I) or Billroth II pancreaticojejunostomy (PJ-II) after pylorus-preserving pancreatoduodenectomy is associated with better postoperative fat absorption, based on residual pancreatic exocrine function. Several reconstructive operations have been employed after pylorus-preserving pancreatoduodenectomy to maximize postoperative nutrition. However, no single-institution study has been published comparing the reconstructive procedures with respect to digestion and absorption of fat. METHODOLOGY: Fat absorption was studied using the 13C-trioctanoin breath test in patients who were grouped according to the degree of fibrosis of the pancreatic remnant, which was determined by histologic examination of the resection specimen. The fibrosis was graded: grade 0, < 10% fibrosis; grade 1, 10-30% fibrosis; and grade 2, > 30% fibrosis. There were 22 patients in the PG-I group and 22 patients in the PJ-II group. RESULTS: There were no significant differences between the PG-I and PJ-II groups in the cumulative excretion of labeled carbon dioxide in the patients with grade 0 pancreatic fibrosis. The cumulative excretion in the PG-I group was better than in the PJ-II group in the patients with grade 1 and grade 2 pancreatic fibrosis. CONCLUSIONS: Fat absorption after PG-I is superior to that after PJ-II in patients with disordered exocrine function of the pancreatic remnant. Billroth I pancreaticogastrostomy allows more effective utilization of the exocrine enzymes of the pancreatic remnant due to elimination of the blind loop characteristic of the Billroth II pancreaticojejunostomy.

Absorption↗
PubMed1975

Pylorus-preserving gastrectomy for gastric ulcer--one- to nine-year follow-up study.

Of 100 patients subjected to pylorus-preserving gastrectomy for surgical treatment of gastric ulcer, 60 were available for follow-up for periods of from one to 9 years. Questionnaires and personal interviews of these 60 and additional laboratory examinations of 40 of them showed results tending to favor the procedure as a highly recommendable technique of gastrectomy. Questions about body weight gain, return to preoperative occupation, and satisfaction with the operation all were answered favorably. In the follow-up laboratory examinations, reduction rates of 57.2 percent for maximal acid concentration, 81.6 percent for maximal acid output, and 70.8 percent for peak acid output. Sphincteric function was generally well preserved on the pyloric ring. Gastric emptying times, ranging from 30 to 180 minutes in 79 percent of the cases, were nearly compatible with the control figures. The results of fat and protein absorption tests performed on some of these patients showed their rates to be within normal ranges. No instances of dumping syndrome, recurrence of ulcer, or other significant postgastrectomy sequelae were recognized. The results indicate pylorus-preserving gastrectomy to be preferable for the surgical treatment of gastric ulcer and other benign lesions of the stomach.

Adult↗
PubMedDate not supplied

Indications for pylorus-preserving gastrectomy for gastric cancer based on lymph node metastasis.

BACKGROUND/AIMS: It is necessary to study the relation between lymph node metastasis in the suprapyloric or lesser curvature regions and clinicopathologic findings in order to determine the indications for pylorus-preserving gastrectomy. METHODOLOGY: We reviewed all pertinent data from the cases of 109 patients with gastric cancer located mainly in the middle third of the stomach focusing particularly on status of lymph node metastasis and clinicopathologic findings. All patients had been treated by conventional gastrectomy with regional lymph node dissection (D2 or D3). RESULTS: Lymph node metastases were found in the lesser curvature or suprapyloric regions in 18 patients. Primary tumors were located in the lesser curvature side in 15 of these 18 patients and in the greater curvature side in only 3. Primary tumors in the greater curvature side with involvement in the lesser curvature or suprapyloric lymph nodes were greater than 4.0 cm in diameter, whereas primary tumors in the lesser curvature side with such metastasis were greater than 1.3 cm. CONCLUSIONS: Indications for pylorus-preserving gastrectomy with preserving of the pyloric branch of the vagal nerve perhaps can be expanded to middle stomach cancer located in the greater curvature side that is less than 4.0 cm in diameter.

Adenocarcinoma↗
PubMed2002

[Long-term clinical results after highly selective vagotomy plus pylorus-preserved mucosal antrectomy].

OBJECTIVE: To study the long-term clinical results of 34 chronic duodenal ulcer patients treated with high selective vagotomy plus pylorus-preserved mucosal antrectomy (HSV + PPMA). METHODS: Clinical follow-up results of the patients from 8 approximately 14 years were analyzed. RESULTS: Thirty-tow patients (94.1%) followed-up for 8 approximately 14 years after operation achieved Visick grades I-II. No patient died. Gastric acid secretion and infection rate of Helicobacter pylori in the antral mucosa were significantly reduced after operation. No significant difference was found in bile acids, total bacterial counts in gastric juice, and the level of serum gastrin after operation. Gastric emptying was normal. No ulcer recurrence was found by barium meal and endoscopy. CONCLUSIONS: HSV + PPMA is a better operative treatment for duodenal ulcer, which not only can decrease acid secretion and ulcer recurrence rate but also can preserve the function of antrum and pylorus and prevent post-operation bile reflux and intragastric bacterial overgrowth.

Adolescent↗
PubMed1992

Involvement of central GABAA receptor complex in controlling the basal gastric secretory activity in pylorus-ligated rats.

Effect of compounds related to gamma-aminobutyric acid (GABA) receptor complex on gastric acid secretion was studied to clarify a role of endogenous GABA in controlling the basal secretory activity in pylorus-ligated rats. When pentobarbital, a GABAA stimulant, was given to pylorus-ligated rats after recovery from ether anesthesia, the drug did not modify gastric acid secretion. In contrast, pentobarbital significantly stimulated acid secretion in rats anesthetized with urethane. The basal acid secretion was much higher in the rats without urethane anesthesia. Diazepam, an agonist of the benzodiazepine (BZP) receptor, did not change gastric acid secretion in both the animal groups. Picrotoxin, pentylenetetrazol (PTZ) and bicuculline, which block GABAergic mediation, significantly reduced gastric acid secretion in rats without urethane anesthesia. Moreover, the inhibition by picrotoxin was reversed completely by pentobarbital and moderately by diazepam, while the inhibition by PTZ was partly reversed by pentobarbital but not affected by diazepam. These findings suggest that the central GABAA receptor complex may play a significant role in controlling the basal gastric secretory activity. The direct involvement of the BZP receptor may be small, if any. The stimulatory mechanism through the mediation of GABAA receptor complex appears to be demonstrable when the basal secretory activity is lowered.

Analysis of Variance↗
PubMed1984

Double pylorus or antro-bulbar fistula.

A patient suffering from rheumatoid arthritis and a gastric ulcer was found endoscopically to have a double pylorus. One year later the two apertures were found to be fused and appeared endoscopically like a deformed pylorus. We suggest that this lesion, which is usually acquired but may sometimes be congenital, would be better called antro-bulbar fistula.

Adult↗
PubMed1994

[Risks of radical treatment in pylorus preserving duodenopancreatectomy in ductal carcinoma].

Between 1986 and 1993 fifty-two patients with ductal adenocarcinoma of the pancreatic head underwent pancreatoduodenectomy, 34 in a standard Whipple technique (Whipple), 18 since 1990 preserving the pylorus (PPPD). Operating time was significantly longer for Whipple compared to PPPD (5.5 +/- 1.4 vs. 3.8 +/- 1.0; p < 0.01). Postoperative morbidity (32 vs. 56%) resulted to 50% after PPPD of early postoperative delayed gastric emptying. Hospital mortality was 6% vs. none, respectively. Histopathologic workup of 28 node positive Whipple specimens revealed node involvement in only 11% along the stomach (1) or the pyloric region (2), but in these cases tumors had obviously close relation to the gastric outlet as the reason to chose Whipple. Actuarial survival was very similar in both groups, being 41 vs. 53% at one year, 13 vs. 18% at two years, and only 3.3% at five years for the whole cohort. In conclusion distal gastric resection in Whipple's procedure in ductal carcinoma is oncologically not effective. There is no hazard for survival relating to the preservation of the pylorus. Therefore PPPD as the technically less expensive and for nutritional status more beneficial operation should be the procedure of choice also for this type of tumor.

Aged↗
PubMed1998

[Experimental substantiation and clinical use of pylorus-preserving surgery with vagotomy in complicated duodenal ulcer].

The influence of truncal vagotomy (TV), selective vagotomy (SV) and selective proximal vagotomy (SPV) with concomitant pylorus-preserving duodenoplasty (DP) on gastric secretion, stimulated by pentagastrin, was studied in chronic experiment on dogs with gastric fundus fistulas. SPV with pylorus-preserving DP causes the most prominent influence on neurohormonal phase of gastric secretion. After SPV and DP conduction in 345 patients the result was significantly better than after SPV with gastric drainage operation.

Animals↗
PubMed1998

Feasibility of pylorus-preserving gastrectomy with a wider scope of lymphadenectomy.

OBJECTIVE: To demonstrate the feasibility and safety of pylorus-preserving gastrectomy (PPG) accompanied by complete suprapyloric and infrapyloric lymph node dissection. DESIGN: Retrospective review. SETTING: A university hospital in Japan. PATIENTS: Fifteen patients underwent PPG, and 28 patients underwent conventional distal gastrectomy (CDG) with Billroth I anastomosis. All patients had early gastric cancer, with either limited invasion in the mucosal layer or invasion into the submucosal layer. INTERVENTIONS: In the PPG procedure, the distal part of the stomach was resected while retaining a 1.5-cm pyloric cuff. The right gastroepiploic artery, the right gastric artery, and hepatic and pyloric branches of the vagus nerve were divided, and the infrapyloric artery was preserved. A modified D1 or D2 lymphadenectomy accompanied the PPG. MAIN OUTCOME MEASURES: Patients undergoing the PPG and CDG procedures were assessed 1 year after their surgical procedure. Changes in body weight, serum total protein levels, and serum albumin levels, the incidence of dumping syndromes, and endoscopic findings in the gastric remnant were compared between the 2 groups. RESULTS: Weight loss was significantly less in the PPG group than in the CDG group (P=.02). The incidences of early dumping syndromes, especially vasomotor symptoms, were significantly lower in the PPG group than in the CDG group (P=.03 and P=.02, respectively). The pyloric sphincter function was preserved, and there was no anastomotic leakage in the PPG group. CONCLUSIONS: The PPG procedure with complete D2 lymphadenectomy can be performed safely with a low incidence of major complications and a better postoperative outcome than the CDG procedure. The PPG procedure can be recommended for the treatment of early gastric cancer with broader indications.

Aged↗
PubMed2005

Effect of antecolic reconstruction on delayed gastric emptying after the pylorus-preserving Whipple procedure.

HYPOTHESIS: Antecolic duodenojejunostomy prevents delayed gastric emptying (DGE) after a pylorus-preserving Whipple (ppW) procedure better than retrocolic duodenojejunostomy. DESIGN: A single operation team's experience with antecolic and retrocolic duodenojejunostomy in ppW is analyzed on a prospective database using univariate and multivariate models. SETTING: Tertiary referral center that focuses on pancreatic diseases. PATIENTS AND INTERVENTIONS: One hundred consecutive patients undergoing a ppW procedure with retrocolic reconstruction between January 1, 1996, and December 31, 2001, and 100 consecutive patients undergoing a ppW procedure with antecolic reconstruction between January 1, 2002, and December 31, 2003. Characteristics such as median age, median hospital stay, sex, diagnosis, previous operations, blood loss, surgical and medical complications, American Society of Anesthesiologists risk groups, stent implantation, and especially DGE were matched for the comparison groups. MAIN OUTCOME MEASURES: We compared DGE, characteristics, and perioperative variables in patients with antecolic vs retrocolic reconstruction after ppW. RESULTS: The DGE occurred significantly more often in patients with retrocolic reconstruction than in those with antecolic reconstruction (P < .001). The antecolic and retrocolic study groups were comparable in age (P = .25), sex (P = .48), and postoperative surgical (P = .19) and medical (P = .054) complications. The univariate analysis between patients with and without DGE did not show significant differences regarding diagnosis, previous operations, blood loss, surgical and medical complications, American Society of Anesthesiologists classification, or stent implantation. In the multivariate analysis, only the type of reconstruction (P = .006) and sex (P = .04) seemed to affect DGE. CONCLUSION: We recommend antecolic duodenjejunostomy in patients undergoing a ppW procedure regardless of their diagnosis.

Aged↗