Pylorus-Resecting Pancreaticoduodenectomy: How I Do It

  • Manabu Kawai
  • Hiroki YamaueEmail author


Pylorus-resecting pancreaticoduodenectomy (PrPD) is one of the procedures that may be recommended for treatment of periampullary neoplasms including pancreatic cancer. Two meta-analyses regarding comparison between PrPD and pylorus-preserving pancreaticoduodenectomy (PpPD) reported that PrPD resulted in a significant reduction of the incidence of delayed gastric emptying compared to PpPD. However, further studies are required to clarify the long-term QOL and/or nutritional status resulting after the use of these techniques.


Pylorus-resecting pancreaticoduodenectomy Pylorus-preserving pancreaticoduodenectomy Delayed gastric emptying 


  1. 1.
    Das Carnimom KW. der Papilla duodeni und seine radikale Entfernung. Beitr Klin Chir. 1912;78:439–86.Google Scholar
  2. 2.
    Whipple AO, Parsons W, Mullins CR. Treatment of carcinoma of the ampulla of Vater. Ann Surg. 1935;102:763–79.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Watson K. Carcinoma of the ampulla of Vater. Successful radical resection. Br J Surg. 1944;31:368–73.CrossRefGoogle Scholar
  4. 4.
    Traverso LW, Longmire WJ. Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet. 1978;146:959–62.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Traverso LW, Longmire WJ. Preservation of the pylorus in pancreaticoduodenectomy: a follow-up evaluation. Ann Surg. 1980;192:306–10.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Jimenez RE, Femandez-del Castillo C, Rattner DW, et al. Outcome of pancreaticoduodenectomy with pylorus preservation or with antrectomy in the treatment of chronic pancreatitis. Ann Surg. 2000;231:293–300.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Brasssch JW, Deziel DJ, Rossi RL, et al. Pyloric and gastric preserving pancreatic resection. Experience with 87 patients. Ann Surg. 1986;204:411–8.CrossRefGoogle Scholar
  8. 8.
    Hunt DR, McLean R. Pylorus-preserving pancreatectomy: functional results. Br J Surg. 1989;76:173–6.CrossRefPubMedGoogle Scholar
  9. 9.
    van Berge Henegouwewn MI, van Gulik TM, De Wit LT, et al. Delayed gastric emptying after standard pancreaticoduodenectomy versus pylorus-preserving pancreaticoduodenectomy: an analysis of 200 consecutive patients. J Am Coll Surg. 1997;185:373–9.CrossRefGoogle Scholar
  10. 10.
    Hayashibe A, Kameyama M, Shinbo M, et al. The surgical procedure and clinical results of subtotal stomach preserving pancreaticoduodenectomy (SSPPD) in comparison with pylorus preserving pancreaticoduodenectomy (PPPD). J Surg Oncol. 2007;95:106–9.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Kawai M, Tani M, Hirono S, Miyazawa M, Shimizu A, Uchiyama K, et al. Pylorus ring resection reduces delayed gastric emptying in patients undergoing pancreatoduodenectomy: a prospective randomized controlled trial of pylorus-resecting versus pylorus-preserving pancreatoduodenectomy. Ann Surg. 2011;253:495–501.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Ohwada S, Satoh Y, Kawate S, Yamada T, Kawamura O, Koyama T, et al. Low-dose erythromycin reduces delayed gastric emptying and improves gastric motility after Billroth I pylorus-preserving pancreaticoduodenectomy. Ann Surg. 2001;234:668–74.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Park JS, Hwang HK, Kim JK, Cho SI, Yoon DS, Lee WJ, et al. Clinical validation and risk factors for delayed gastric emptying based on the International Study Group of Pancreatic Surgery (ISGPS) Classification. Surgery. 2009;146:882–7.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Itani KM, Coleman RE, Meyers WC, Akwari OE. Pylorus-preserving pancreaticoduodenectomy. A clinical and physiologic appraisal. Ann Surg. 1986;204:655–64.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Gauvin JM, Sarmiento JM, Sarr MG. Pylorus-preserving pancreaticoduodenectomy with complete preservation of the pyloroduodenal blood supply and innervation. Arch Surg. 2003;138:1261–3.CrossRefPubMedGoogle Scholar
  16. 16.
    Fischer CP, Hong JC. Method of pyloric reconstruction and impact upon delayed gastric emptying and hospital stay after pylorus-preserving pancreaticoduodenectomy. J Gastrointest Surg. 2006;10:215–9.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kim DK, Hindenburg AA, Sharma SK, Suk CH, Gress FG, Staszewski H, et al. Is pylorospasm a cause of delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy? Ann Surg Oncol. 2005;12:222–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Kobayashi I, Miyachi M, Kanai M, Nagino M, Kondo S, Kamiya J, et al. Different gastric emptying of solid and liquid meals after pylorus-preserving pancreaticoduodenectomy. Br J Surg. 1998;85:927–30.CrossRefPubMedGoogle Scholar
  19. 19.
    Räty S, Sand J, Lantto E, Nordback I. Postoperative acute pancreatitis as a major determinant of postoperative delayed gastric emptying after pancreaticoduodenectomy. J Gastrointest Surg. 2006;10:1131–9.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Riediger H, Makowiec F, Schareck WD, Hopt UT, Adam U. Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy is strongly related to other postoperative complications. J Gastrointest Surg. 2003;7:758–65.CrossRefPubMedGoogle Scholar
  21. 21.
    Yeo CJ, Barry MK, Sauter PK, Sostre S, Lillemoe KD, Pitt HA, et al. Erythromycin accelerates gastric emptying following pancreaticoduodenectomy: a prospective, randomized placebo-controlled trial. Ann Surg. 1993;218:229–38.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Kurosaki I, Hatakeyama K. Preservation of the left gastric vein in delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy. J Gastrointest Surg. 2005;9:846–52.CrossRefPubMedGoogle Scholar
  23. 23.
    Kurahara H, Takao S, Shinchi H, et al. Subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) prevents postoperative delayed gastric emptying. J Surg Oncol. 2010;102:615–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Fujii T, Kanda M, Kodera Y, et al. Preservation of the pyloric ring has little value in surgery for pancreatic head cancer: a comparative study comparing three surgical procedures. Ann Surg Oncol. 2012;19:176–83.CrossRefPubMedGoogle Scholar
  25. 25.
    Nanashima A, Abo T, Sumida Y, et al. Comparison of results between pylorus-preserving pancreaticoduodenectomy and subtotal stomach-preserving pancreaticoduodenectomy: report at a single cancer institute. Hepatogastroenterology. 2013;60:1182–8.PubMedGoogle Scholar
  26. 26.
    Hackert T, Hinz U, Hartwig W, et al. Pylorus resection in partial pancreaticoduodenectomy: impact on delayed gastric emptying. Am J Surg. 2013a;206:296–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Matsumoto I, Shinzeki M, Asari S, et al. A prospective randomized comparison between pylorus- and subtotal stomach-preserving pancreatoduodenectomy on postoperative delayed gastric emptying occurrence and long-term nutritional status. J Surg Oncol. 2014;109:690–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142:761–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Hanna MM, Gadde R, Tamariz L, et al. Delayed Gastric Emptying After Pancreaticoduodenectomy: Is Subtotal Stomach Preserving Better or Pylorus Preserving? J Gastrointest Surg. 2015;19:1542–52.CrossRefPubMedGoogle Scholar
  30. 30.
    Huang W, Xiong JJ, Wan MH, et al. Meta-analysis of subtotal stomach-preserving pancreaticoduodenectomy vs pylorus preserving pancreaticoduodenectomy. World J Gastroenterol. 2015;21:6361–73.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Nakamura T, Ambo Y, Noji T, et al. Reduction of the Incidence of Delayed Gastric Emptying in Side-to-Side Gastrojejunostomy in Subtotal Stomach-Preserving Pancreaticoduodenectomy. J Gastrointest Surg. 2015;19:1425–32.CrossRefPubMedGoogle Scholar
  32. 32.
    Hackert T, Bruckner T, Dörr-Harim C, et al. Pylorus resection or pylorus preservation in partial pancreatico-duodenectomy (PROPP study): study protocol for a randomized controlled trial. Trials. 2013;14:44.CrossRefPubMedPubMedCentralGoogle Scholar

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© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Second Department of SurgerySchool of Medicine, Wakayama Medical UniversityWakayamaJapan

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