What is pylorus-preserving pancreaticoduodenectomy?
During the operation, the following are removed:
- the head of the pancreas
- the duodenum
- the gallbladder
- the distal part of the common bile duct
- the regional lymph nodes
Unlike the classic Whipple procedure, *the pylorus and stomach are preserved*, which avoids gastric resection provided this is oncologically safe.
After the resection stage, the digestive tract is reconstructed by creating a pancreaticojejunostomy, a hepaticojejunostomy, and a duodenojejunostomy.
Our approach
At MSI, tumors of the pancreaticoduodenal region are treated in line with guidelines from the *NCCN, ESMO, and ISGPS (International Study Group of Pancreatic Surgery)*.
Before surgery, every patient undergoes full staging of the disease using multiphase CT or MRI, laboratory tests, tumor markers, and, when indicated, endoscopic ultrasound or biopsy.
We perform the pylorus-preserving operation only when *it does not reduce the oncological radicality of treatment*. If the tumor does not extend to the gastric antrum or pylorus, preserving the pylorus is safe and appropriate.
*When technically feasible and oncologically safe, we aim to perform the operation laparoscopically.* This reduces surgical trauma, speeds up recovery, and shortens the hospital stay.
Postoperative care follows the principles of *ERAS (Enhanced Recovery After Surgery)*.
When is surgery needed?
Pylorus-preserving pancreaticoduodenectomy is performed for:
- cancer of the head of the pancreas
- tumors of the major duodenal papilla
- cancer of the distal common bile duct
- duodenal cancer
- neuroendocrine tumors of the head of the pancreas
- certain precancerous and benign pancreatic lesions
Indications for surgery
Surgery is recommended for:
- resectable tumors of the pancreaticoduodenal region
- the possibility of preserving the pylorus without compromising oncological principles
- no tumor invasion of the gastric antrum
- no distant metastases
How is the operation performed?
The procedure is performed under general anesthesia.
After the pancreaticoduodenal complex is mobilized, the head of the pancreas, the duodenum, the gallbladder, and the distal bile duct are resected while the pylorus is preserved. A regional lymph node dissection is performed at the same time.
Once the resection stage is complete, a pancreaticojejunostomy, a hepaticojejunostomy, and a duodenojejunostomy are created.
The removed specimen is always sent for histopathological examination.
Advantages of laparoscopic surgery
- Performed laparoscopically whenever possible
- Preservation of the pylorus and the entire stomach
- Less surgical trauma
- Less postoperative pain
- Faster return to physical activity
- Lower risk of wound complications
- Shorter hospital stay
- Full adherence to the principles of oncological radicality
Recovery after surgery
Postoperative treatment follows *ERAS* principles. Eating is resumed gradually, and pancreatic function, blood glucose, and the function of the anastomoses are monitored.
If necessary, enzyme replacement therapy is prescribed. Further treatment is decided once the histopathology results are available.
Our advantages
- Specialization in pancreatic surgery
- A commitment to laparoscopic surgery when it is safe and oncologically justified
- An organ-preserving approach with the option of preserving the pylorus
- Modern techniques for reconstructing the digestive tract
- Multidisciplinary treatment planning
- Adherence to NCCN, ESMO, and ISGPS guidelines
- Enhanced recovery program (ERAS)
Frequently Asked Questions
The main difference is that the pylorus and the entire stomach are preserved. This may allow more physiological passage of food and better nutritional status after surgery.
No. The pylorus can be preserved only when the tumor does not extend to the gastric antrum and this does not worsen the oncological outcome.
Yes. When indicated and oncologically safe, we aim to perform pylorus-preserving pancreaticoduodenectomy laparoscopically.
Some patients need enzyme replacement therapy after surgery. The need for treatment is decided individually.
Further treatment depends on the histopathology results and is decided by the multidisciplinary team in line with modern international guidelines.