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PubMed2000

Marginal ulceration after pylorus-preserving pancreaticoduodenectomy.

Marginal ulceration is a serious problem after both standard pancreaticoduodenectomy (PD) and pylorus-preserving pancreaticoduodenectomy (PPPD). The relationship between this complication and the method of reconstruction after PPPD was analyzed in this study. Patients who underwent standard PD (n = 72) or PPPD (n = 28) in the 20-year period from 1978 to 1997 were retrospectively reviewed. After PPPD, 4 patients (14.3%) developed marginal ulceration on the jejunal side of the duodenojejunal anastomosis, while none of the patients had marginal ulceration after standard PD. The marginal ulcer occurred in 3 of 14 patients treated with the Roux-en-Y method, and in 1 of 9 treated with pancreatogastrostomy. In the Roux-en-Y method, the anal jejunal loop anastomosed to the bulb was directly exposed to gastric juice without neutralization by pancreatic juice from the oral jejunal limb. Of the 4 patients with marginal ulceration, 2 of those treated by the Roux-en-Y method required gastrectomy; the other 2 patients were treated medically. Our analysis of the literature showed that the Roux-en-Y method had the highest incidence of marginal ulcerations. The gastrointestinal reconstruction method without a mixture of gastric juice and pancreatic juice may be a causal factor in the marginal ulceration that occurs after PPPD. In reconstruction after PPPD, we should not create a jejunal loop that is exposed to gastric juice alone.

Aged↗

PubMed2002

Pylorus-preserving pancreatoduodenectomy with Billroth I type reconstruction: a viable option for pancreatic head resection.

BACKGROUND/PURPOSE: The aim of this study was to investigate the efficacy of pylorus-preserving pancreatoduodenectomy (PPPD) versus standard pancreatoduodenectomy (PD). METHOD: A cohort of 80 patients were studied for 5 years using prospectively gathered data. PPPD was performed in 48 (60%) patients, and the other 32 (40%) underwent a standard Whipple's operation with partial distal gastrectomy (PD). In all cases, the gastric or duodenal stump was anastomosed with the first loop of jejunum as a Billroth I-type reconstruction. RESULTS: Overall, morbidity in the cohort of patients consisted of 10 with a pancreatic fistula, 5 with postoperative hemorrhage, 5 with sepsis, 3 with delayed gastric emptying, 2 with an anastomotic leak, and 1 each with intraabdominal hematoma or myocardial infarction. Major morbidity associated with PPPD appeared in 8 of the 48 (16.7%) patients compared with 2 of 32 (6.3%) in the PD group. There were two deaths (4.2%) in the PPPD group and one (3.1%) in the PD group. The mean length of hospital stay was 14.6 days for PPPD versus 17.1 days for PD. Of the 48 patients in the PPPD group 7 (14.6%) had a hospital stay of more than 20 days versus 8 of the 32 (25%) in the PD group. CONCLUSIONS: Contrary to recent reports, in our series the PPPD patients had a shorter hospital stay; and overall, 3 of the 80 (3.75%) patients developed delayed gastric emptying, a relatively low rate. The pancreatic fistula rate was almost threefold higher in the PPPD group than in the PD group (but did not prolong the inpatient stay). This may be due to an intact antrum secreting higher quantities of gastrin.

Adult↗

PubMed2000

Thoracic esophagectomy combined with pylorus-preserving pancreatoduodenectomy in a one-stage procedure: report of a case.

We present herein the case of a patient who underwent a thoracic esophagectomy and pylorus-preserving pancreatoduodenectomy in a one-stage procedure for synchronous double primary cancer of the thoracic esophagus and the head of the pancreas (intraductal papillary tumor). To reconstruct the upper alimentary tract with the stomach, the gastroduodenal artery and right gastroepiploic vein were successfully skeletonized and preserved. The postoperative course was uneventful and the patient is currently well, 5 years after surgery.

Aged↗

PubMed1975

Gastroenteric anastomosis in Billroth II gastrectomy with maintenance of the physiologic diameter of the normal pylorus to prevent the dumping syndrome. Part II. Results in 1,300 cases.

Clinical results of the use of a gastroenteric anastomosis with a diameter the size of the normal pylorus (1.9 cm) in 1,300 cases between 1954 and 1971 are presented mainly in terms of prevention of the dumping syndrome. We have had no patient with clinical manifestations of any degree of the dumping syndrome in the first two years after operation. These excellent results have led us to employ the method routinely. We recommend this method for its simplicity and, above all, its effectiveness in preventing the dumping syndrome.

Dumping Syndrome↗

PubMed1979

Neural control of the canine pylorus.

After atropine administration the anesthetized dog exhibits significant spontaneous pyloric contractile activity and an inhibition-relaxation response upon electrical vagal stimulation. This inhibition-relaxation response was completely blocked by tetrodotoxin administration and by transection of the intraabdominal vagal nerves. In addition, tetrodotoxin administration caused a dramatic increase in spontaneous pyloric motor activity. The histaminergic receptor antagonists diphenhydramine and cimetidine did not block the inhibition-relaxation response. The octapeptide of cholecystokinin (CCK-OP) caused a dose-dependent increase in antral and pyloric motor activity which was significantly decreased by atropine administration. Therefore, histamine and CCK do not appear to play a significant role in the vagally mediated inhibition-relaxation response of the canine pylorus or in the atropine-resistant spontaneous pyloric motor activity.

Animals↗

PubMed1976

Effects of zinc chloride on gastric secretion and ulcer formation in pylorus-occluded rats.

The effects of 10-day pretreatment with i.p. injections of zinc chloride, 16 mg/kg, on gastric secretion and on gastric ulceration induced by stress or by acid accumulation were examined in pylorus-occluded rats. Zinc chloride pretreatment significantly reduced the volume of gastric secretion and the total acid output as well as the incidence of gastric ulcers induced either by stress or by acid accumulation. The findings support the idea zinc compounds may be useful in the treatment of gastric ulcers.

Animals↗

PubMed1987

Role of pylorus in the control of the canine migrating motor complex.

The cyclic myoelectric activity of the gastroduodenal area and the antral mucosal ionic permeability, measured by the transmural potential difference, were simultaneously evaluated in the dog. These parameters were recorded before and after section of the omental attachments to the pyloric area, section of the terminal antrum, and excision of a 2-cm segment at the pylorus. None of the surgical procedures modified the duration of the postprandial disruption of the migrating motor complexes, whereas the potential difference was increased. In fasted dogs resection of the omentum increased the migrating motor complex intervals and the duration of the phase of regular spiking activity; however, the regular spiking activities still occurred in a sequential manner. Transection of the terminal antrum was associated with a decrease in duration of the regular spiking activity phases that started simultaneously on the antrum and duodenum, without changes in the migrating motor complex intervals, and prevented the occurrence of the increase in potential difference associated with feeding. After pylorectomy, the migrating motor complex intervals were reduced by 46% on both antrum and duodenum. Our observation that only pylorectomy was able to consistently increase the frequency of migrating motor complexes suggests a pyloric inhibition of the normal pacing of the cyclic motor events at both antral and duodenal levels.

Animals↗

PubMed1988

Relationship of the motor activity of the antrum, pylorus, and duodenum to gastric emptying of a solid-liquid mixed meal.

The postprandial motor activity of the antrum, pylorus, and duodenum in 15 healthy volunteers was compared with the profiles of emptying of the solid and liquid components of a meal. The liquid component of the meal emptied rapidly in an exponential manner, whereas the solid remained in the fundus of the stomach until approximately 80% of the liquid had emptied and then emptied in a linear manner. The onset of solid emptying was associated with an increase in the rate of occurrence of antral pressure waves (p less than 0.05), and the half-time for solid emptying (t1/2 - lag period) was inversely correlated (p less than 0.05) with the rate of coordinated contractions involving the antrum. The substitution of 25% dextrose in normal saline as the liquid component of the meal increased the half-time for liquid emptying from a median of 8 to 40 min (p less than 0.01), increased the lag period for solid emptying from 40 to 87 min (p less than 0.01), and increased the rate of occurrence of isolated pyloric pressure waves during the solid lag phase from 7 to 58/h (p less than 0.05), but did not affect the slope of solid emptying or the rate of coordinated contractions involving the antrum during the solid emptying period.

Adolescent↗

PubMed1977

Ulcer reduction by non-nutritive bulk in pylorus ligated rats.

The effects of solid non-nutritive diet on pylorus-ligation ulcers were tested. An experimental group of 16 rats received a bulky mixture of silica and methylcellulose during 48 hr prior to ligation. Control rats were food deprived for the same period of time. A multivariate analysis of variance was applied to nine measures of the study. It was found that rumenal ulceration and total acidity were lower in experimental animals than in controls. This finding confirms a previous observation indicating that the physical property of diet has antiulcerogenic effects.

Animals↗

PubMed1996

Nitric oxide synthase-containing nerve elements in the pylorus of the cat.

Combined nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) histochemistry, nitric oxide synthase (NOS) and vasoactive intestinal polypeptide (VIP) immunocytochemistry were used to study the distribution of NOS- and VIP-containing nerve elements in the feline pylorus. A large number of stained multipolar neurons was found in the myenteric plexus. However, some NADPH-d and NOS positive neurons were also observed in the submucous plexus and in the internal part of muscular layer. A few stained perikarya were found in the tunica mucosa, in a very close situation to the blood vessels. A large number of thin varicose fibres, with intense reaction for all markers were seen around or in close contact with the unstained perikarya to the blood vessels and some of them around the pyloric glands. The density of NOS and NADPH-d positive nerve elements was much higher than that of VIP-immunoreactive (IR) nerve elements. Our results suggest that nitric oxide (NO) might act as a regulatory neurotransmitter of the pyloric sphincter, blood flow and secretion in this region.

Animals↗

PubMed1983

Pathologic effects of fractionated fast neutrons or photons on the pancreas, pylorus and duodenum of dogs.

Thirty-nine adult male Beagles received either fast neutron or photon irradiation to the right thorax to determine the relative biological effectiveness (RBE) of fast neutrons on normal pulmonary tissue. The right anterior abdomen was included in the field of radiation. Twenty-four dogs (six/group) received fast neutrons with an average energy of 15 MeV to total doses of 1000, 1500, 2250 or 3375 rad in four fractions per week for six weeks. Fifteen dogs received 3000, 4500 or 6750 rad of photons (five/group) in an identical fractionation pattern. All neutron irradiated dogs receiving 3375 and 2250 rad and one receiving 1500 rad developed clinical signs of pancreatic, hepatic and gastrointestinal disturbances. The liver enzymes of these dogs became elevated and they died or were euthanatized in extremis 47-367 days after irradiation. Only one 6750 rad photon dog developed similar signs and died 708 days post-irradiation. Five neutron and 10 photon exposed dogs died of other causes. Neutron-induced lesions in the stomach and duodenum included hemorrhages, erosions, ulcerations and fibrosis. Ulcers perforated the GI tract of five dogs. Pancreatic lesions included degranulation and necrosis of acinar cells, fibrosis ans atrophy. Islet cells were not obviously damaged. All lesions were associated with degenerative and occlusive vascular changes. The RBE of fast neutrons, assessed by clinical signs, gross and microscopic pathology, is approximately 3-4.5 for pancreas and about 4.5 for pylorus and duodenum.

Animals↗

PubMed2006

Double pylorus.

Double pylorus is a rare abnormality and it occurs most commonly secondary to chronic peptic ulcer disease. It is usually treated conservatively with anti-ulcer therapy. However, refractory cases may require surgery.

Aged↗

PubMed2006

Fibromatosis of the remnant pancreas after pylorus-preserving pancreaticoduodenectomy.

Intra-abdominal fibromatosis or desmoid tumors are rare forms of connective tissue cellular dysplasia characterized by proliferation of fibroblasts and abundant collagen. Most often these tumors associated with familial adenomatous polyposis or Gardner's syndrome. Those tumors not associated with polyposis are termed sporadic desmoids and tend to be locally aggressive in nature. Sporadic intra-abdominal desmoids involving the pancreas are quite rare, as only six previously reported cases exist. In this report we present a seventh case of a sporadic intraabdominal desmoid involving the pancreas. The patient, a 63-year-old white man, developed the desmoid tumor following a pylorus-preserving pancreaticoduodenectomy for an insulinoma. The patient was managed via further pancreatectomy, consisting of a distal pancreatectomy with en bloc splenectomy, sparing a 6-cm portion of pancreatic neck and proximal body. Finally, we present a complete review of the six previous cases of sporadic pancreatic fibromatosis.

Fibroma↗

PubMed2006

Laparoscopy-assisted pylorus-preserving gastrectomy with quality controlled lymph node dissection in gastric cancer operation.

BACKGROUND: Pylorus-preserving gastrectomy (PPG) with extensive lymph node dissection is useful for treatment of early gastric cancer with preservation of function. This technique could be improved by using laparoscopy-assisted gastrectomy. STUDY DESIGN: Between September 2000 and September 2004, 109 patients with T1 gastric cancer underwent surgical treatment; 72 underwent laparoscopy-assisted PPG (LAPPG) and 37 underwent conventional PPG (CPPG). Total numbers of dissected lymph nodes, retrieval at each lymph node station, intraoperative blood loss, and operation times were used as measures of the quality of lymph node dissection to compare the procedures. Continuous data are summarized as mean +/- SE. RESULTS: Operation times with the LAPPG procedure (279 +/- 6 minutes) were significantly, but only 20 minutes, longer than with CPPG (259 +/- 8 minutes) (p = 0.047), although estimated blood loss for LAPPG patients (153 +/- 13 mL) was not significantly different for those undergoing CPPG (184 +/- 13 mL, p = 0.13). Mean total number of dissected lymph nodes was 32.3 +/- 1.6 in the LAPPG group and 28.5 +/- 2.2 in the CPPG group (p = 0.16). There was no significant difference in the number of lymph nodes retrieved for any of the nodal stations between the LAPPG and CPPG procedures. CONCLUSIONS: Clinical outcomes of surgical treatment were comparable for gastric cancer patients who underwent LAPPG and those treated with CPPG in terms of station-dependent lymph node dissection and estimated blood loss.

Adenocarcinoma↗

PubMed2001

A vertical stomach reconstruction after pylorus-preserving pancreaticoduodenectomy.

BACKGROUND: Pancreatic fistula (PF) and delayed gastric emptying (DGE) is a leading cause of morbidity after pylorus-preserving pancreaticoduodenectomy (PPPD), occurring in 20% to 40% of patients. METHODS: Between August 1994 and March 2000, 30 consecutive patients underwent our modified PPPD and were evaluated on their incidence of PF and DGE. The major modification of our technique was an antecolic reconstruction and setting the transverse colon between pancreaticogastrostomy and duodenojejunostomy RESULTS: Operative time and blood loss were, respectively, 5.2+/-0.93 hours and 730+/-330 mL. Hospital mortality was 0%. Postoperative morbidity was 23%. Delayed gastric emptying and pancreatic fistula were observed in 3 (10%) and 0 (0%) of 30 patients. Nasogastric suction was required for 7+/-2 days, and a solid diet could be tolerated on postoperative day 11+/-4. CONCLUSIONS: The results show that our reconstruction can minimize DGE.

Aged↗

PubMed2001

Quality of life after pylorus-preserving pancreatoduodenectomy.

BACKGROUND: With increasing numbers of long-term survivors after pylorus-preserving pancreatoduodenectomy (PPPD), postoperative quality of life (QOL) has become a great concern. However, few reports are available on data of the postoperative changes in QOL after PPPD. METHODS: A total of 20 patients were studied regarding QOL before and at short term (within 2 months), intermediate term (6 months), and long term (1 year) after PPPD, using a questionnaire. The questionnaire consisted of 13 physical and 10 psychosocial items. The medical records were also reviewed to evaluate objective nutritional status. Factors predicting delayed recovery of QOL were examined at intermediate term by univariate and multivariate analyses. RESULTS: Overall and physical QOL scores returned to the preoperative level at intermediate term after PPPD, showing parallel changes with the objective nutritional status. However, the scores of psychosocial condition, which reflected the patient's mental health, remained low even at long term. QOL scores at intermediate term in patients with pancreatic carcinoma were significantly lower than those with other diseases. Univariate analysis showed that preoperative body weight loss, impaired preoperative pancreatic exocrine function, long operative time, intraoperative radiotherapy, pancreatic carcinoma, and postoperative diarrhea were factors predicting the delayed recovery of QOL. Multivariate analysis revealed that preoperative pancreatic exocrine function significantly affected the delayed recovery of QOL. CONCLUSIONS: Preoperative supplement of pancreatic enzymes together with perioperative mental care would improve QOL at long term after PPPD.

Adult↗

PubMed1998

Comparison of relapse and long-term survival between pylorus-preserving and Whipple pancreaticoduodenectomy in periampullary cancer.

BACKGROUND: Whether long-term survival and type of recurrence in periampullary cancer are influenced by the type of surgical procedure or not is still obscure. The purpose of this review was to analyze the results at a single institution. METHODS: Between 1982 and 1996, 113 consecutive patients with either distal bile duct or ampullary cancers underwent either pylorus-preserving pancreaticoduodenectomy (PPPD) or the Whipple procedure. The median follow-up was 30 months (range 12 to 150). Patient records were reviewed to determine type of recurrence and survival. RESULTS: In distal bile duct or ampullary cancers, comparison of actuarial survival curves between PPPD and the Whipple operation revealed no significant differences. Even in node-positive patients, the 5-year survival rates did not differ significantly between those undergoing PPPD or the Whipple operation. Tumor recurrence was not correlated with the operative method, although among types of tumor recurrence, the rate of blood-borne metastasis was higher in distal bile duct or ampullary cancers. CONCLUSIONS: PPPD is an acceptable alternative to the Whipple procedure in the treatment of periampullary cancer. Long-term survival and type of recurrence were not influenced by these types of surgical procedures.

Adult↗

PubMed1988

Radiographic and ultrasound appearances of an intra-mural haematoma of the pylorus.

The case of a haemophilic baby boy who developed a pyloric haematoma due to trauma caused by a feeding gastrostomy catheter balloon is presented. Intramural gastric haematomas are rare and the authors are not aware of any previous reports of intramural haematomas affecting the pylorus alone in this age group. The barium meal appearances of the pyloric haematoma were identical to those seen in hypertrophic pyloric stenosis but ultrasound demonstrated a circumferential pyloric haematoma.

Gastrointestinal Hemorrhage↗