A COMPARISON OF LONG-TERM RESULTS OF THE STANDARD WHIPPLE PROCEDURE AND THE PYLORUS-PRESERVING PANCREATICODUODENECTOMY

The standard Whipple procedure involves intestinal disturbances, such as dumping, diarrhea, dyspeptic complaints and the occurrence of ulcer s of the anastomoses. A postoperative weight loss was observed ranging between 10 and 40 kilograms. Only a few patients were able to compens ate after several months. It was thought that preservation of the inta ct stomach would prevent the complications arising from a loss of gast ric reservoir function and thus the malnutrition could be improved pos toperatively. Between 1985 and March 1992, we performed the pylorus-pr eserving Whipple procedure and treated a group of 43 patients with thi s method. In the same period, 15 patients were operated upon with the standard Whipple procedure. The present evaluation of the accumulated patient data, including extensive functional studies, led to the follo wing results comparing the pylorus preserving Whipple procedure with t he standard Whipple procedure. First, the capacity for food uptake and the development of body weight postoperatively is significantly bette r. Second, gastric or jejunal ulcers were not observed. Third, there w ere no clinical signs of digestive disorders, such as different forms of dumping. Nutrition and digestion were not impeded by the preserved opening mechanism of the pylorus. Fourth, the postoperative exocrine f unction was only slightly decreased. Fifth, glucose metabolism postope ratively was influenced only slightly by preservation of the pylorus. In taking the results of all the examinations into consideration, it c an be said that the restricted organ loss in the Whipple procedure wit h pylorus preservation leaves the secretory and functional capacity of the upper part of the gastrointestinal tract almost unchanged.