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Prospective randomised comparison of organ-preserving pancreatic head resection with pylorus-preserving pancreaticoduodenectomy

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Abstract

Background and aims

In a prospective, randomised, control trial organ-preserving pancreatic head resection (OPPHR) was compared with pylorus-preserving pancreaticoduodenectomy (PPPD) to assess the advantages and disadvantages of each type of operation.

Patients and methods

Forty patients were allocated randomly to either the OPPHR (n=20) or the PPPD (n=20) group. The surgical data, postoperative complications, induction of diabetes mellitus, postoperative pain and quality of life 1 year, postoperatively, were considered.

Results

The two study groups of 20 patients were well balanced with regard to sex, age, chronic pancreatitis history and indication for surgery. The duration of the operation for OPPHR and PPPD was 142.5±4.9 and 278±6.9 min, respectively (P<0.05). The postoperative mortality in each group was zero. After OPPHR and PPPD, the morbidity was 0 and 40%, respectively (P<0.05). The duration of hospital stay was also significantly different: 8.05±0.9 vs 13.8±3.9 days (P<0.05). After 1 year the pain relief was effective in both groups, but three patients acquired diabetes mellitus after PPPD; the body weight had increased by 7.8±0.9 and 3.2±0.3 kg after OPPHR and PPPD, respectively (P<0.05).

Conclusion

The two procedures are equally safe and effective with regard to pain relief, but OPPHR is superior to PPPD not only in the operation data and morbidity, but also in the quality of life 1 year postoperatively. OPPHR should be regarded as a recommended procedure in the treatment of chronic pancreatitis.

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References

  1. Beger HG, Schlosser W, Poch B, Gansague F (1998) Inflammatory mass in the head of the pancreas. In: Beger HG, Warshaw AL, Büchler MW, Carr-Locke DL, Neoptolemos JP, Russell C, Sarr MG (eds) The Pancreas, vol 1. Blackwell Science, Oxford, London, pp 757–760

    Google Scholar 

  2. Traverso LW, Longmire WP (1978) Preservation of the pylorus during pancreatico-duodenectomy. Surg Gynecol Obstet 146:959–962

    PubMed  CAS  Google Scholar 

  3. Beger HG, Krautzberger W, Bittner R, Büchler M, Limmer J (1985) Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis. Surgery 97:467–473

    PubMed  CAS  Google Scholar 

  4. Gloor B, Friess H, Uhl W, Büchler MW (2001) A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis. Dig Surg 18:21–25

    Article  PubMed  CAS  Google Scholar 

  5. Köninger J, Friess H, Müller M, Wirtz M, Martignioni M, Büchler MW (2004) Duodenum-preserving pancreas head resection—an operative technique for retaining the organ in the treatment of chronic pancreatitis. Chirurg 75:781–788

    Article  PubMed  Google Scholar 

  6. Frey CF, Child CG, Fry W (1976) Pancreatectomy for chronic pancreatitis. Ann Surg 184:403–414

    Article  PubMed  CAS  Google Scholar 

  7. Farkas G, Leindler L, Daróczi M, Farkas G Jr (2003) Organ-preserving pancreatic head resection in chronic pancreatitis. Br J Surg 90:29–32

    Article  PubMed  CAS  Google Scholar 

  8. Farkas G, Leindler L, Farkas G Jr, Daróczi M (2004) Organ-preserving resection of the pancreatic head in patients with chronic pancreatitis. Magy Seb 57:279–282

    PubMed  Google Scholar 

  9. Löser C, Möllgaard A, Fölsch UR (1996) Faecal elastase1: a novel, highly sensitive, and specific tubeless pancreatic function test. Gut 39:580–586

    Article  PubMed  Google Scholar 

  10. Flautner L, Tihanyi T, Szécsény A (1985) Pancreatogastrostomy: an ideal complement to pancreatic head resection with preservation of the pylorus in the treatment of chronic pancreatitis. Am J Surg 150:608–611

    Article  PubMed  CAS  Google Scholar 

  11. Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman J, Zahurak ML, Grochow LB, Abrahams RA (1997) Six hundred fifty consecutive pancreaticoduodectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226:248–257

    Article  PubMed  CAS  Google Scholar 

  12. Hartel M, Tempia-Caliera AA, Wende MN, Z’graggen K, Friess H, Büchler MW (2003) Evidence-based surgery in chronic pancreatitis. Langenbeck’s Arch Surg 388:132–139

    Google Scholar 

  13. Jimenez RE, Fernandez-del Castillo C, Rattner DW, Warshaw AL (2003) Pylorus-preserving pancreatoduodenectomy in the treatment of chronic pancreatitis. World J Surg 27:1211–1216

    Article  PubMed  Google Scholar 

  14. Beger HG, Schlosser W, Friess HM, Büchler MW (1999) Duodenum-preserving head resection in chronic pancreatitis changes the natural course of the disease: a single-centre 26-year experience. Ann Surg 230:512–519

    Article  PubMed  CAS  Google Scholar 

  15. Büchler MW, Friess H, Muller MW, Wheatley AM, Beger HG (1995) Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis. Am J Surg 169:65–69

    Article  PubMed  Google Scholar 

  16. Klempa I, Spatny M, Menzel J, Baca I, Nustede R, Stockmann F, Arnold W (1995) Pancreatic function and quality of life after resection of the head of pancreas in chronic pancreatitis: a prospective, randomized comparative study after duodenum preserving resection of the head of the pancreas versus Whipple’s operation. Chirurg 66:350–359

    PubMed  CAS  Google Scholar 

  17. Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Broelsch CE (1995) Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis. A prospective randomized trial. Ann Surg 221:350–358

    Article  PubMed  CAS  Google Scholar 

  18. Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Soehendra N, Broelsch CE (1997) Drainage versus resection in surgical therapy of chronic pancreatitis of the head of the pancreas. Chirurg 68:369–377

    Article  PubMed  CAS  Google Scholar 

  19. Markowitz JS, Rattner DW, Warshaw AL (1994) Failure of symptomatic relief after pancreatojejunal decompression for chronic pancreatitis. Arch Surg 129:374–380

    PubMed  CAS  Google Scholar 

  20. Izbicki JR, Bloechle C, Broering DC, Knoefel WT, Kuechler T, Broelsch CE (1998) Extended drainage versus resection in surgery for chronic pancreatitis. Ann Surg 228:771–779

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Gyula Farkas.

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Farkas, G., Leindler, L., Daróczi, M. et al. Prospective randomised comparison of organ-preserving pancreatic head resection with pylorus-preserving pancreaticoduodenectomy. Langenbecks Arch Surg 391, 338–342 (2006). https://doi.org/10.1007/s00423-006-0051-7

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  • DOI: https://doi.org/10.1007/s00423-006-0051-7

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