Journal
WORLD JOURNAL OF GASTROENTEROLOGY
Volume 12, Issue 37, Pages 5951-5958Publisher
BAISHIDENG PUBLISHING GROUP INC
DOI: 10.3748/wjg.v12.i37.5951
Keywords
pylorus-preserving pancreaticoduodenectomy; Whipple pancreaticoduodenectomy; delayed gastric emptying; pancreatic surgery
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Pylorus-preserving pancreaticoduodenectomy (PPPD) is nowadays considered the treatment of choice for periampullary tumors, namely carcinoma of the head, neck, or uncinate process of the pancreas, the ampulla of Vater, distal common bile duct or carcinoma of the peri-Vaterian duodenum. Delayed gastric emptying (DGE) comprises one of the most troublesome complications of this procedure. A search of the literature using Pubmed/Medline was performed to identify clinical trials examining the incidence rate of DGE following standard Whipple pancreaticoduodenectomy (PD) vs PPPD. Additionally we performed a thorough in-depth analysis of the implicated pathomechanism underlying the occurrence of DGE after PPPD. In contrast to early studies, the majority of recently performed clinical trials demonstrated no significant association between the occurrence of DGE with either PD or PPPD. PD and PPPD procedures are equally effective operations regarding the postoperative occurrence of DGE. Further randomized trials are required to investigate the efficacy of a recently reported (but not yet tested in large-scale studies) modification, that is, PPPD with antecolic duodenojejunostomy. (C) 2006 The WJG Press. All rights reserved.
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