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PubMed1980

Acquired double pylorus due to gastroduodenal fistula complicating peptic ulceration.

Fistulous communication between the gastric antrum and the duodenal bulb had the roentgenographic appearance of a double-channel pylorus in five adult patents. A penetrating peptic ulcer was the underlying cause in each instance. Following conservative management, the fistula in two cases closed spontaneously and in two other cases became asymptomatic despite persistence of the accessory channel. The remaining patient underwent subtotal gastrectomy because of hemorrhage from nonhealing antral ulcer.

Adult↗
PubMed1995

Pylorus-preserving Whipple resection for pancreatic cancer. Is it any better?

OBJECTIVE: To compare the short- and long-term morbidity and mortality rates of the standard Whipple pancreatoduodenectomy (SW) and its pylorus-preserving modification (PPW) in patients with malignant periampullary disease. DESIGN: Retrospective medical record review and quality of life assessment by telephone interview. SETTING: University medical center. STUDY PARTICIPANTS: Sixty-seven patients who underwent pancreatoduodenectomy (52 SW and 15 PPW) from June 1988 to January 1994. INTERVENTION: The SW and PPW. MAIN OUTCOME MEASURES: Operative features and short- and long-term complications were analyzed with respect to the type and stage of cancer and the kind of pancreatic resection. Mean follow-up was 32 months (range, 1 to 5 years). RESULTS: The operative mortality rate for all patients who had a pancreatic resection was 1.5%. The diagnoses in the PPW vs SW groups were pancreatic cancer (four vs 27 patients), ampullary cancer (six vs seven patients), duodenal cancer (zero vs six patients), and bile duct cancer (five vs one patient). Operative mortality rates (0% vs 1.55%) and operative times (2 minutes longer for SW) were similar. Delayed gastric emptying (61% vs 41%) was more common in the PPW group, resulting in a longer hospitalization (24 vs 18 days) and a greater cost in the PPW group (P = .04). In the PPW group, a mean of five lymph nodes was removed compared with 10 in the SW group (P = .04). CONCLUSIONS: The data provided no evidence of any advantage for the PPW in patients with malignant periampullary tumors. We continue to advocate the SW for pancreatic cancer.

Adult↗
PubMed1996

Long-term results of pylorus-preserving pancreatoduodenectomy for chronic pancreatitis.

OBJECTIVE: To assess the long-term outcome of patients following pylorus-preserving pancreatoduodenectomy (PPPD) for chronic pancreatitis. DESIGN: Retrospective study with mean follow-up of 63 months (range, 1 month to 13.7 years). SETTING: Tertiary referral hospital. PATIENTS: Records of all patients who underwent PPPD for chronic pancreatitis at Lahey Clinic were reviewed. All patients who were alive were contacted by telephone. In cases where patients had died, information was gathered from family members and hospital records. RESULTS: Forty-five patients underwent PPPD for disabling chronic pancreatitis. The mean preoperative duration of pain was 50 months, with 32 patients (70%) requiring daily narcotics. In one patient resection of the portal vein was required. One patient died within 30 days of the operation. Forty-one patients (92%) had improvement of pain at 5 years. The mean pain score (on a scale of 0 to 10) was 9.2 preoperatively and 1.5, 0.8, 1.1, and 1.1 at 6 months, 1 year, 2 years, and 5 years, respectively. Thirty-three patients (74%) had a postoperative weight gain to an average of 92% of their pre-illness weight. New-onset diabetes occurred in six patients (14%) by 6 months and in 21 patients (46%) by 5 years. Hypoglycemia was the cause of death in one patient who underwent total pancreatectomy. Four patients died of causes unrelated to PPPD. Marginal ulcers occurred in five patients (10%). Nine patients required late operations. CONCLUSIONS: In selected patients, resection of the head of the pancreas achieves long-term pain improvement in over 90% of cases. The early development of diabetes mellitus is infrequent, but over longer follow-up periods it reaches prevalence rates similar to those described in patients who have not undergone resection. Weight gain in this group was superior to that previously reported for our patients who underwent "standard Whipple" operation for chronic pancreatitis.

Adult↗
PubMed1975

The importance of an innervated and intact antrum and pylorus in preventing postoperative duodenogastric reflux and gastritis.

This study has investigated the relationship between duodenogastric reflux, gastritis and certain symptoms 6-12 months after three operations for uncomplicated duodenal ulcer. The operations studied were proximal gastric vagotomy (PGV, 20 cases), truncal vagotomy and pyloroplasty (TV+P, 22 cases) and truncal vagotomy and antrectomy (TV+A, 21 cases). Duodenogastric reflux was assessed both by a radiological technique and by measuring the concentration of bilirubin in the gastric aspirate before and after operation. Incidence and severity of postoperative gastritis were determined by endoscopic biopsy. Symptoms were assessed by symptomatic score and Visick grading. There was a significant correlation between duodenal reflux and histological evidence of both severe superficial gastritis and glandular atrophy (P less than 0-01). There was also a close association between the degree of reflux and the presence of severe heartburn, epigastric pain and bile vomiting after operation. The amount of reflux did not differ before operation. There was significantly less reflux following PGV than after either TV+P (P less than 0-025) or TV+A (P less than 0-001). The results indicate that an operation which preserves an innervated and intact antrum and pylorus will protect against postoperative duodenogastric reflux, gastritis and symptoms.

Adult↗
PubMed1989

Pylorus-preserving pancreatectomy: functional results.

The pylorus-preserving technique is reported as improving the functional results of pancreatectomy but it is complicated in the early postoperative period by delayed recovery of gastric function in a proportion of patients. We have examined early and late gastrointestinal function in a prospective study of 16 patients having this procedure. The late results appear better than reported results for conventional Whipple resection and the delay in early recovery does not appear to have any late sequelae, provided that it does not require gastric bypass for relief.

Adult↗
PubMed1990

Asymmetrical nature of the muscular anatomy of the infantile pylorus: a possible consideration in pyloromyotomy.

Post-mortem studies of the normal infantile pylorus have demonstrated an asymmetrical structure with the mucosa protruding under the circular muscle at the lesser curve but not on the anterior surface. In addition the circular muscle was often discontinuous at the pyloroduodenal junction with only longitudinal fibres or even fibrous tissue separating the mucosa from the serosa. In a further specimen in which a pyloromyotomy had been performed 10 weeks previously, this asymmetry was more pronounced. This anatomy suggests that in pyloric stenosis it may be safer to site the caudal part of the pyloromyotomy incision on the anterior surface, rather than on the anterosuperior surface as most authors recommend. Perforation of the mucosa is predicted to be less likely.

Humans↗
PubMed1994

Plasma gastrin and cholecystokinin responses after pylorus-preserving pancreatoduodenectomy and defunctioned Roux loop pancreaticojejunostomy.

Several methods can be used to re-establish gastrointestinal continuity after the standard Whipple's Billroth II procedure or Longmire pylorus-preserving pancreatoduodenectomy (PPPD). Standard pancreatoduodenectomy abolishes the postprandial gastrin response whereas the response after Longmire PPPD is similar to that in controls. A novel reconstruction after PPPD has been designed to separate the biliary and pancreatic secretions by restoring continuity in the Billroth I manner, retaining the gastric antrum and with the pancreatic remnant anastomosed to a separate defunctioned Roux loop. Gastrin and cholecystokinin (CCK) responses were measured in the fasting state and after a standard liquid meal of 250 ml containing 15 per cent protein, 30 per cent fat and 55 per cent carbohydrate with an energy value of 525 kJ. Basal gastrin and CCK concentrations were similar in five healthy unoperated controls, and after standard pancreatoduodenectomy (five patients) and isolated Roux loop PPPD (six patients). In controls and after the new PPPD operation, but not after standard pancreatoduodenectomy, mean(s.e.m.) postprandial plasma gastrin values rose from 8.66(0.33) to 13.00(0.33) pmol l-1 at 10 min (controls) and from 7.66(1.56) to 15.00(1.36) pmol l-1 at 10 min (defunctioned Roux loop PPPD); the concentration remained raised for 20 min then fell transiently; a second peak was maintained for 40 min (controls) to 60 min (modified PPPD). In controls, mean(s.e.m.) postprandial plasma CCK concentrations rose from 0.43(0.12) basal to 10.50(1.03) pmol l-1 and returned to basal after 60 min. After standard pancreatoduodenectomy postprandial CCK concentrations rose at a similar rate and remained raised for 80 min. After isolated Roux loop PPPD plasma CCK concentrations remained low (mean(s.e.m.) 0.38(0.29) pmol l-1) after the test meal.

Aged↗
PubMed1995

Comparison between pylorus-preserving and Whipple pancreatoduodenectomy.

Between 1989 and 1993, 62 patients underwent Whipple pancreatoduodenectomy and 75 pylorus-preserving pancreatoduodenectomy (PPPD); 35 patients in the first group and 37 in the second had pancreatic adenocarcinoma while 17 and 21 patients respectively had periampullary adenocarcinoma. The aim of this retrospective study was the comparison of operative outcome, nutritional recovery and survival of patients who underwent these two operations. No significant differences were found between the two groups in operative mortality or morbidity, duration of gastric aspiration and time to start of solid meals. Patients who underwent PPPD had a better nutritional recovery: the increase of both body-weight and serum albumin level at 6 months after discharge was significantly higher for those who had preservation of the whole stomach (P < 0.001 and P < 0.05 respectively). No significant difference in survival was found between the two procedures when patients with pancreatic or periampullary adenocarcinoma were analysed separately.

Adult↗
PubMed2004

Pylorus-preserving pancreaticoduodenectomy for advanced duodenal disease in familial adenomatous polyposis.

BACKGROUND: Although only 5 per cent of patients with familial adenomatous polyposis (FAP) die from duodenal cancer, a recent study indicated that the mortality rate is much higher in patients with Spigelman stage IV disease. This has prompted an increased rate of referral for excisional surgery and an analysis of the results. METHODS: Between January 1994 and June 2002, 16 patients with FAP (mean age 55 years; eight men) were referred to a single surgeon for pylorus-preserving pancreaticoduodenal resection for Spigelman stage IV duodenal adenomatosis. RESULTS: One patient died from multiple organ failure after relaparotomy for haemorrhage and a jejunal perforation; other major complications included anastomotic leak (one), primary haemorrhage (one), lymphatic leak (one), chylous ascites (one), pulmonary embolus (two) and prolonged delayed gastric emptying that required total parenteral nutrition (three). Overall there were 11 major complications in eight patients. Two patients developed insulin-dependent diabetes and one postprandial dumping. Postoperative histological examination revealed five unsuspected cancers, which led to four deaths within 3 years of surgery. One patient died 2 months after surgery from pulmonary thromboembolism and another at 5 months from an inoperable brain tumour. Nine of the 16 patients were alive and well at a mean of 38 months after surgery. CONCLUSION: The choice between continued endoscopic surveillance and excisional surgery for Spigelman stage IV duodenal disease remains finely balanced.

Adenomatous Polyposis Coli↗
PubMed1982

A study of the extrinsic innervation of the guinea pig pylorus with the horseradish peroxidase tracing technique.

The extrinsic innervation of the guinea pig pylorus was studied by the use of the horseradish peroxidase (HRP) tracing technique. Forty-eight hours after injection of HRP into the pyloric sphincter labeled neurons of varying sizes were found throughout the rostrocaudal extent of the dorsal motor nuclei of the vagus. No HRP positive cells were seen in the medial solitary nuclei or the ambiguous nuclei. Many HRP-positive cells were observed in the celiac-superior mesenteric ganglion complex. Occasional cells in the superior cervical and stellate ganglia were also labeled. When the vagal ganglia were analyzed many enzyme-containing cells were found in the nodose ganglia and some cells in the jugular ganglia. Furthermore, about 15-20% of the labeled afferent neurons were located in dorsal root ganglia on both sides, with the majority of cells at the T5--T10 levels. The results are discussed in relation to recent transmitter histochemical findings as well as possible functional roles of the neurons.

Animals↗
PubMed1997

Helicobacter pylori lipopolysaccharide inhibits acid secretion in pylorus-ligated conscious rats.

To examine the effect of Helicobacter pylori lipopolysaccharide on gastric secretion, the present study was carried out using pylorus ligated conscious rats. Intraperitoneal administration of Helicobacter pylori lipopolysaccharide significantly inhibited gastric acid secretion (4 hr) in a dose-dependent manner (0.033-1.0 mg/rat). The Helicobacter pylori lipopolysaccharide (1 mg/rat)-induced acid inhibition was still observed 8 hr after injection. Gastric acid secretion (4 hr) was compared in the rats that had received intraperitoneal administration of 1 mg/rat dose of Helicobacter pylori lipopolysaccharide or saline alone 24 hr before. There was no significant difference in gastric acid secretion between the saline- and H. pylori lipopolysaccharide-treated rats. These results suggest for the first time that H. pylori lipopolysaccharide may inhibit acid production, and this acid inhibition may be long-lasting. It is also demonstrated that this anti-secretory action of H. pylori lipopolysaccharide has a reversible effect on gastric secretion. All these results suggest that H. pylori lipopolysaccharide might be involved in the low acid secretory function seen in patients with acute H. pylori infection.

Animals↗
PubMed1999

Jejunal pouch interposition after pylorus-preserving gastrectomy.

BACKGROUND: To improve the quality of life of patients undergoing gastrectomy, a nerve-conserving jejunal pouch was interposed after pylorus-preserving gastrectomy (PPG) with vagal nerve preservation. We report the details of the operative technique and the outcome. METHODS: PPG with lymph node dissection was performed, preserving the hepatic, pyloric, and celiac branches of vagal nerve. The jejunum was cut approximately 20 cm distal to the ligament of Treitz. Marginal vessels were not divided in order to preserve the nerves in the jejunum that were used to construct the pouch. A linear stapler was used to perform a side-to-side jejunojejunostomy. A 12-cm-long pouch was formed by firing the stapler twice. The pouch was interposed between the residual parts of the stomach. Postoperatively, the patients were interviewed periodically. A dual-phase, dual-isotope radionucleid pouch-emptying study was performed 6 months after surgery. RESULTS: A total of 13 patients underwent the operation. No complication developed. During the first 6 months after surgery, the body weight of the patients was maintained at 91% of the preoperative level. The radioisotope retention rate for the combined pouch and residual stomach was 46% for liquid food and 76% for solid food 120 min after ingestion. The pattern of its emptying was similar to that in healthy individuals. CONCLUSIONS: The pouch-emptying test demonstrated a satisfactory retention capacity and acceptable emptying for the gastric substitute. A reasonably good quality of life has been obtained for patients undergoing PPG with interposition of a nerve-preserving jejunal pouch.

Aged↗
PubMed1991

Pylorus-preserving pancreatoduodenectomy--technical aspects.

Pylorus-preserving pancreatododenectomy is the resection of choice for patients with carcinoma of the head of the pancreas and periampullary area and for certain patients with chronic pancreatitis. Preoperative preparation, operative technique, and results are discussed.

Duodenum↗
PubMedDate not supplied

Early postoperative evaluation of pylorus-preserving gastrectomy for gastric cancer.

Early postoperative evaluation was prospectively performed in 35 gastric cancer patients after pylorus-preserving gastrectomy (PPG) between 1989 and 1991, comparing the results with those of 29 patients who underwent conventional distal gastrectomy (CDG). Surgical stress, including the duration of operation (149.0 +/- 4.3 minutes) and the total volume of bleeding at operation (97.0 +/- 11.2 g), was significantly less in the PPG patients. Early postoperative complications were seen in 31% after PPG and in 35% after CDG. The most frequent complication in PPG patients was remnant gastric stasis (23%). Endoscopy showed redness or erosion (or both) of the gastric remnant in 17% after PPG and in 81% after CDG. Bile regurgitation was demonstrated in 11% after PPG and in 62% after CDG. In PPG patients, the pyloric ring opened and closed during the examination. Gastric pH was 4.2 +/- 0.4 in PPG patients but was significantly lower in CDG patients. The resting gallbladder area, examined by ultrasonography, demonstrated no changes after PPG but was significantly enlarged after CDG (from 11.3 +/- 1.2 cm2 to 15.8 +/- 1.5 cm2 at 2 weeks). The percentage of the original resting gallbladder area at 20 minutes after injection of cerulein increased slightly in PPG patients but recovered thereafter, whereas in CDG patients it increased significantly (from 39.4 +/- 8.3% to 66.7 +/- 9.1% at 2 weeks). No gallstone formation was detected throughout the observation period after PPG, whereas after CDG it was detected in two patients at 1 year.(ABSTRACT TRUNCATED AT 250 WORDS)

Barium↗
PubMed1975

A contribution to the knowledge of the so-called pyloric band ("double pylorus").

Two new cases of patients with so called muscular pyloric band ("double pylorus") are reported. Both possible genetic mechanisms of this malformation are discussed in detail: primary or congenital, and secondary or acquired by inflammation. After analysis of the hitherto related cases, the opinion is expressed that the so called pyloric band represents a congenital malformation. According to the authors, the striking frequency of simultaneous occurrence of pyloric band and ulcers does not necessarily favour the theory of inflammatory genesis. The accompanying ulcer seems rather to be a "second disease" in the sense of Rossle (1913), manifesting itself at a locus minoris resistentiae.

Aged↗
PubMed1981

[The myoarchitecture of the pylorus (author's transl)].

The gastric pylorus is not a constricting sphincter but a valve closing on distension, resembling the situation in the lower esophageal sphincter. Both contiguous segments (stomach and duodenum) are able to regulate its function physiologically allowing also some degree of reflux.

Adult↗
PubMedDate not supplied

Experimental study of pylorus and pyloric vagus preserving gastrectomy.

In an attempt to prevent the sequelae of conventional gastrectomy, such as rapid gastric emptying, dumping syndrome, intestinal content reflux, indigestion, and poor absorption, we have devised the pylorus and pyloric vagus preserving gastrectomy (PPVPG). Experimenting on 48 dogs, we found theoretic grounds for using our design and obtained the desired effects--retaining the merits of conventional subtotal resection of the stomach, with acidity reduction, while avoiding the above-mentioned complications.

Animals↗