Pylorus-preserving pancreaticoduodenectomy is an accepted treatment for benign and malignant diseases of the pancreas. Some element of delayed gastric emptying affects as many as 46% of patients.1,2 Although usually transient, delayed gastric emptying may extend length of hospital stay and persist for several weeks. In addition to pancreatic anastomotic leaks,3 reduced blood flow and compromised innervation to the antral-pyloric pump mechanism have been implicated as causes.4- 6
Operative view of the anterior side of the stomach (thick black arrow), the fully preserved gastrohepatic ligament (thin black arrow), and the duodenal transection (thin white arrow). The thick white arrow indicates the pylorus.
Operative view of the posterior side of the distal lesser curvature of the stomach retracted anteriorly, preserved gastroduodenal artery (small white arrows), common bile duct (large white arrow), and superior mesenteric vein (black arrow).
Preservation of the gastroduodenal artery (GDA) as viewed from the anterior surface of the pancreas. Dissection proceeds distal to the origin of the right gastroepiploic artery (RGEA), which is preserved. The superior pancreaticoduodenal artery (SPDA) is ligated and divided at its origin. The branches to the duodenum from the GDA are carefully preserved (inset).
The common bile duct and portal vein are approached from the right, behind the duodenum (arrow), thus preserving all neurovascular tissue along the lesser curvature of the stomach.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Surgery editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 16
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.