A vertical stomach reconstruction after pylorus-preserving pancreaticoduodenectomy

Background: Pancreatic fistula (PF) and delayed gastric emptying (DGE) is a leading cause of morbidity after pylorus-preserving pancreaticoduodenectomy (PPPD), occurring in 20% to 40% of patients. Methods: Between August 1994 and March 2000, 30 consecutive patients underwent our modified PPPD and were evaluated on their incidence of PF and DGE. The major modification of our technique was an antecolic reconstruction and setting the transverse colon between pancreaticogastrostomy and duodenojejunostomy Results: Operative time and blood loss were, respectively, 5.2 ± 0.93 hours and 730 ± 330 mL. Hospital mortality was 0%. Postoperative morbidity was 23%. Delayed gastric emptying and pancreatic fistula were observed in 3 (10%) and 0 (0%) of 30 patients. Nasogastric suction was required for 7 ± 2 days, and a solid diet could be tolerated on postoperative day 11 ± 4. Conclusions: The results show that our reconstruction can minimize DGE.