Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy

This study compares postoperative gastric emptying after pancreaticoduodenectomy with antrectomy (Whipple operation) or with preservation of the antrum and pylorus (Longmire operation). Six of eight patients with antrectomy were able to tolerate full solid feedings within ten days (a mean for the group--9.8 days). Only one of eight patients with preservation of the antrum and pylorus reached this point within ten days (a mean for the group--16 days, p less than 0.05). Average-time from operation to discharge from the hospital was seven days longer for patients in the latter group. Routine placement of a gastrostomy tube in anticipation of the prolonged need for gastric drainage reduced a potentially bothersome problem to a well-tolerated level. Although one patient had bleeding jejunal ulcers develop which required vagotomy and antrectomy one year after a Longmire operation; the long term nutritional and functional advantages of this new technique for pancreaticoduodenectomy seem to outweigh the short term costs.