[Pancreatoduodenal resection with preservation of the pylorus]

Experience with 106 pancreatoduodenal resections (PDR) with pylorus savage for tumors and benign diseases of pancreatic head and periampullar zone is analyzed. Features of mobilization of pancreatoduodenal complex in PDR are shown. They permit to reduce the rate of complications (gastrostasis). Necessity of differential approach to choice of creation of biliodigestive anastomosis is demonstrated. Risk of postoperative pancreatitis is highest in non-dilated pancreatic duct and small-changed pancreatic parenchyma. In these cases terminolateral pancreatojejunostomy with external drainage of pancreatic duct (12 patients) and pancreatogastrostomy (21) are preferable. PDR with pylorus savage permitted to use wider pancreato-, bilio- and duodenoenteroejunoanastomosis on one loop of the jejunum. Gastrostasis was seen in 50% patients after PDR with pylorus savage. Technical features of surgery and also postoperative complications leading to gastrostasis are demonstrated.