Complications after pancreaticoduodenectomy: a prospective randomized comparison between pylorus-preserving pancreaticoduodenectomy and Whipple procedure

From August 1994 to August 1997, we conducted a prospective, randomized comparison between classic Whipple procedure and PPPD performed by the same surgeon with same approach and same anastomotic fashion for periampullary cancers. After exclusion there were 31 patients eligible for the study; 16 receiving PPPD and 15 Whipple procedures. One operative mortality in PPPD(6%) and no operative death in Whipple procedure resulted in a 3.2% mortality rate in 31 patients. Median duration of the operation performed in the Whipple procedure was 235 minutes(range: 190-305 min), with a median blood loss of 500mL(range: 250-3100mL) and a median blood transfusion of 0 unit (range: 0-10 units). In the group of patients with PPPD, median operation time was 230 minutes (range: 170-275 min), median blood loss was 350mL (range: 100-1200mL) and median blood transfusion was 0 unit (range: 0-4 units). The difference for operation time, blood loss, and blood transfusion between two groups was not significant. There were two minor leakage from the pancreaticojejunostomy in Whipple procedure and no leakage in PPPD, resulting in 6% minor leakage in 31 patients. Delayed gastric emptying was observed in one patient in Whipple procedure (6%) and 6 patients in PPPD (37%), which was significantly different. In our prospective randomized study, both PPPD and Whipple procedure had low mortality and low operative morbidity, but PPPD had more frequent delayed gastric emptying. There was no significant difference between PPPD and Whipple procedure in terms of operation time, blood loss and blood transfusion.