Comparison between pylorus-preserving whipple operation and duodenum-preserving pancreatic head resection

Background: Which surgical treatment to use in patients suffering from chronic pancreatitis is still controversial. It is now agreed that the classical Whipple resection, which has been the standard operation in chronic pancreatitis for several decades, should be replaced by organ-preserving surgical procedures. The pylorus-preserving Whipple (PPW) resection, a modification of the classical Whipple operation, and the duodenum-preserving pancreatic head resection (DPPHR) are 2 competitive operations performed on patients with chronic pancreatitis and pancreatic head-related complications. Methods: We discuss short and long-term results of PPW and DPPHR in patients with chronic pancreatitis. In addition, we report on a randomized, controlled clinical trial, comparing the postoperative results following PPW and DPPHR in 40 patients undergoing surgery for chronic pancreatitis. Results: The results of the study indicate that DPPHR can be carried out in chronic pancreatitis with morbidity and mortality rates similar to those of the standard PPW. Furthermore, the study demonstrated the superiority of DPPHR with regard to postoperative quality of life and glucose metabolism, which may be responsible for faster weight gain and convalescence. Complications such as delayed gastric emptying and biliary fistulae, which may lead to morbidity in the early postoperative period following PPW, do not occur after DPPHR. Conclusion: DPPHR provides a better early postoperative outcome, faster convalescence, and a better preservation of the endocrine function than PPW. Therefore, DPPHR should be adopted as a new organ-preserving standard operation in the treatment of pancreatic head complications in chronic pancreatitis.