Pylorus-preserving Pancreatoduodenectomy (PPPD)by Imanaga Procedure for Periampullary Cancer, and Postoperative Endoscopic Findings of Pancreatic and Biliary Stomas (Video presentation) / Шинэ санаа Шинэ нээлт

ABSTRACT

After PPPD, we have consistently performed gastrointestinal reconstruction by Imanaga procedure that entailed an end-to-end dudenojejunostomy, end-toside pancreatojejunostomy (pancreatic duct to jejunal mucosa anastomosis) and choledochojejunostomy, performed in that order. PPPD-Imanaga, which leaves no blind intestinal segment, simulates the normal anatomic arrangement and provides a physiological mixture of food and bile in the upper portion of the jejunum. The good mixing was evidenced by dual scintigraphy with few exceptions. As another advantages, insertion of endoscopy is easier postoperatively and as a result, we can check patency of pancreatic and biliary anastomotic stomas. This is important to evaluate postoperative function of remnant pancreas and liver, and early to detect local recurrence. Since 1986, we have experienced 272 cases of PPPD/PD-Imanaga (PPPD 233 / PD 39), which consists of patients with pancreatic head cancer 122, bile duct cancer 55, Vater cancer 36 and another 61. Overall 5-year-survival is 14.2% in pancreatic head cancer, and 25.3% in distal bile duct cancer.