Pylorus-preserving Pancreaticoduodenectomy for Chronic Pancreatitis: Our Modified Procedures

Yuichiro Hamanaka, Akira Kawamura, Kenji Nishihara, Masahiro Nishikawa, Kouichiro Sakata, Takashi Suzuki

Department of Surgery II, Yamaguchi University School of Medicine

Pylorus-preserving pancreaticoduodenectomy with minimized resection of the duodenum, followed by the Billroth I type of reconstruction was performed in 9 patients with chronic pancreatitis who had an inflammatory tumor including a cyst and/or stone in the head of the pancreas. Anal to duodenoduodenostomy (end-to-end), three types of pancreatobiliary anastomoses were made, taking account of the pathophysiological state of the diseased pancreas. Type A with pancreatojejunostomy (end-to-side) and choledochojejunostomy (end-to-side) was performed in 2 cases; type B with choledochojejunostomy (end-to-side) and pancreatojejunostomy (end-to-side) in 3 cases; and type C with choledochojejunostomy (end-to-side) and pancreaticojejunostomy (side-to-side) in 4 cases. Types A and B were used mainly for patients with a nondilated pancreatic duct. Type C was used for patients having a dilated pancreatic duct with hard pancreas tissue in order to decompress the duct and to removed stones within the remnant pancreas. Pain relief was obtained in 7 of 8 patients (88%). All the patients were discharged without serious postoperative complications. We conclude that our type C reconstruction is a rational modified procedure for chronic pancreatitis with stones and hard pancreatic tissues in regard to postoperative digestion as well as absorption.

Key words
chronic pancreatitis, pylorus-preserving pancreaticoduodenectomy, modified reconstruction

Reprint requests
Yuichiro Hamanaka Department of Surgery II, Yamaguchi University School of Medicine
1144 Kogushi, Ube, 755 JAPAN

Accepted
July 3, 1991

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