Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 7, 2006; 12(37): 5951-5958
Published online Oct 7, 2006. doi: 10.3748/wjg.v12.i37.5951
Delayed gastric emptying is associated with pylorus-preserving but not classical Whipple pancreaticoduodenectomy: A review of the literature and critical reappraisal of the implicated pathomechanism
Kosmas I Paraskevas, Costas Avgerinos, Costas Manes, Dimitris Lytras, Christos Dervenis
Kosmas I Paraskevas, 2nd Departments of Surgery, Agia Olga General Hospital, Athens, Greece
Costas Avgerinos, Costas Manes, Dimitris Lytras, Christos Dervenis, 1st Departments of Surgery, Agia Olga General Hospital, Athens, Greece
Correspondence to: Christos Dervenis, MD, Head of the Department, Unit of Liver Surgery, 1st Department of Surgery, Agia Olga Hospital, 3-5 Agias Olgas Str, Nea Ionia 14233, Greece.
Fax: +30-210-2793969
Received: May 31, 2006
Revised: June 12, 2006
Accepted: June 25, 2006
Published online: October 7, 2006

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.

Keywords: Pylorus-preserving pancreaticoduodenectomy, Whipple pancreaticoduodenectomy, Delayed gastric emptying, Pancreatic surgery