Preservation of the Total Stomach with Selective Proximal Vagotomy in Pancreato-duodenectomy for the Disease of Pancreatic Head

Yozo Watanabe, Hidenori Tsumura, Toshiyuki Nakagawa, Hideki Sakurai, Hiroshi Sasaki, Yasuo Iizuka, Toshio Morimoto, Takanori Haba*, Akio Nohmi*, Seiichi Ono*, Noburu Sakakibara*

The Department of Surgery, Izu-Nagaoka Hospital, Juntendo University School of Medicine
*The First Department of Surgery, Juntendo University School of Medicine

Pancreatoduodenectomy with total stomach preservation and selective proximal vagotomy (SPV) were performed in 2 patients with chronic pancreatitis, 3 patients with malignant tumors and 2 patients with benign tumors.The range of doudenal resection extended from the level 1 cm proximal to the pyloric ring and covered 80 to 90% of the duodenum. SPV was generally performed in the conventional manner, but since this blocks the blood supply to the lesser curvature in the upper portion of the stomach, the right gastric artery was preserved and the right gastroepiploic artery was ligated at the root. Reconstruction was performed in accordance with a modification of Child's method in 6 cases and Imanaga's method in 1 case. As compared to pancreatoduodenectomy with preservation of the duodenal bulb, the present procedure is of wider applicability for malignant tumors, and lymph node dissection up through the scond group was possible. The postoperative time elapsed before removal of the stomach dtube averaged 4.6 days, and no gastric emptying impairment was observed during the eraly postoperative period. the quantity of food ingested after surgery was large, and recovery of body weight was favorable. As regards postoperative gastric acid secretion, both the basal acid output and maximal acid output were markedly decreased.

Key words
pancreatoduodenectomy with total stomach preservation, selective proximal vagotomy, chronic pancreatitis, cancer of pancreas and biliary tract

Reprint requests
Yozo Watanabe Department of Surgery, Juntendo Izu-Nagaoka Hospital, Juntendo University
School of Medicine ll29 Izunagaoka-machi, Tagata-gun, Shizuoka, 410-22 JAPAN

Accepted
January 10, 1990

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