IS PYLORIC FUNCTION PRESERVED IN PYLORUS-PRESERVING PANCREATICODUODENECTOMY

Objective: To assess the function of the pylorus after pylorus-preserv ing pancreaticoduodenectomy (PPPD) done for periampullary or pancreati c cancer. Design: Prospective, observational controlled clinical study . Setting: Teaching hospital, Italy. Subjects: 17 patients who had und ergone PPPD, and 15 healthy control subjects.Investigations: Endoscopy to check for gastritis and marginal ulcers and 24 h-pH monitoring and Tc-99m HIDA scintigraphy to detect jejunogastric reflux. Scintigraphy was also used to evaluate gastric and jejunal transit after a solid m eal labelled with Tc-99m 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 postoper ative 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 gast ric emptying compared with controls, but three patients had prolonged emptying time (T1/2 more than 85 minutes). Endoscopy findings correlat ed with pH monitoring results. Conclusions: After PPPD, most patients have abnormal pyloric function, but it is clinically evident in only a small proportion.