Is pyloric function preserved in pylorus-preserving pancreaticoduodenectomy?

OBJECTIVE

To assess the function of the pylorus after pylorus-preserving pancreaticoduodenectomy (PPPD) done for periampullary or pancreatic cancer.

DESIGN

Prospective, observational controlled clinical study.

SETTING

Teaching hospital, Italy.

SUBJECTS: 17 patients who had undergone PPPD, and 15 healthy control subjects.

INVESTIGATIONS: Endoscopy to check for gastritis and marginal ulcers and 24 h-pH monitoring and 99mTc HIDA scintigraphy to detect jejunogastric reflux. Scintigraphy was also used to evaluate gastric and jejunal transit after a solid meal labelled with 99mTc colloid sulphur.

MAIN OUTCOME MEASURES: Signs of delayed gastric emptying, jejunogastric reflux and gastric outlet obstruction in the short and long term.

RESULTS

In the early postoperative period only 1 patient had delayed gastric emptying. In the long term, two patients had symptoms of dyspepsia and 8/11 showed alkaline reflux with persistent gastric pH more than 4 for more than 12 hours; 3 had histological signs of gastritis. There was no difference in gastric emptying compared with controls, but three patients had prolonged emptying time (T1/2 more than 85 minutes). Endoscopy findings correlated with pH monitoring results.

CONCLUSIONS

After PPPD, most patients have abnormal pyloric function, but it is clinically evident in only a small proportion.