Delayed gastric emptying occurs after pylorus-preserving Whipple, but not after duodenum-preserving pancreatic head resection in patients with chronic pancreatitis

In a prospective randomized controlled unicenter trial we compared the pylorus-preserving Whipple (PW) with the duodenum-preserving pancreatic head resection (DPPHR) in chronic pancreatitis, with regard to postoperative gastric emptying, CCK serum levels and parameters of quality of life. Gastric emptying and CCK serum levels were measured by paracetamol absorption and test meal stimulation. Ten patients with chronic pancreatitis were enrolled in each group. Both groups were well balanced with regard to sex, age and indication for surgery. The paracetamol absorption showed no statistical difference between a control group consisting of 6 healthy volunteers and the patients with chronic pancreatitis. Ten days postoperatively gastric emptying showed a statistically significant reduction in the PW-group but not in the DPPHR-group compared with the preoperatve findings. After 6 months gastric emptying was increased to control levels. The CCK levels showed a trend of reduction 10 days postoperative after PW. The DPPHR-group showed a tendency for better weight increase 6 months postoperatively. 60 % of the patients in boths groups were pain-free, but in the PW group one patient still suffered from severe daily pain. In summary, early after PW a delayed gastric emptying ocurrs, but without major clinical relevance. The DPPHR shows a tendency for faster reconvalecence, better weight gain and pain relief compared with the PW.