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. 1979 Jul;190(1):1–5. doi: 10.1097/00000658-197907000-00001

Anastomotic ulceration following subtotal and total pancreatectomy.

C S Grant, J A Van Heerden
PMCID: PMC1344446  PMID: 313757

Abstract

Ulcerogenic potential exists after subtotal gastrectomy, pancreatic resection and separation of the pancreatic and bile ducts from the gastric outlet. Collectively, as with radical pancreatoduodenectomy or total pancreatectomy, a substantial risk of an anastomotic ulcer developing can be expected. To elucidate this, we reviewed the records of 297 patients who had undergone either radical pancreatoduodenectomy (Whipple procedure) or total pancreatectomy. We found that 18 patients (6%) had developed an anastomotic ulcer and that total pancreatectomy was statistically more ulcerogenic than a Whipple procedure. An anastomotic ulcer a virulent complication; two-thirds of the patients had bleeding, and it was a contributing cause of death in 22% of patients in whom ulcer developed. In patients who have a favorable prognosis, the addition of vagectomy to either procedure should be considered.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BALINT J. A., COOPER G. W., PRICE E. C., PULVERTAFT C. N., SWYNNERTON B. F. The management of anastomotic ulcer. Lancet. 1957 Sep 21;273(6995):551–555. doi: 10.1016/s0140-6736(57)90055-7. [DOI] [PubMed] [Google Scholar]
  2. Cleator I. G., Holubitsky I. B., Harrison R. C. Anastomotic ulceration. Ann Surg. 1974 Mar;179(3):339–351. doi: 10.1097/00000658-197403000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Condon J. R., Tanner N. C. Retrospective review of 208 proved cases of anastomotic ulcer. Gut. 1968 Aug;9(4):438–441. doi: 10.1136/gut.9.4.438. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. EVERSON T. C., ALLEN M. J. Gastrojejunal ulceration. AMA Arch Surg. 1954 Aug;69(2):140–147. doi: 10.1001/archsurg.1954.01270020006002. [DOI] [PubMed] [Google Scholar]
  5. Elliott D. W. Effect of lost pancreatic juice on gastric acid and peptic ulcer. Am J Surg. 1974 Jun;127(6):658–662. doi: 10.1016/0002-9610(74)90342-0. [DOI] [PubMed] [Google Scholar]
  6. Goligher J. C., Pulvertaft C. N., De Dombal F. T., Conyers J. H., Duthie H. L., Feather D. B., Latchmore A. J., Shoesmith J. H., Smiddy F. G., Willson-Pepper J. Five to eight-year results of Leeds-York controlled trial of elective surgery for duodenal ulcer. Br Med J. 1968 Jun 29;2(5608):781–787. doi: 10.1136/bmj.2.5608.781. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. HERRINGTON J. L., Jr, EDWARDS W. H., EDWARDS L. W. Reevaluation of the surgical treatment of duodenal ulcer. Surgery. 1961 Apr;49:540–549. [PubMed] [Google Scholar]
  8. Howard R. J., Murphy W. R., Humphrey E. W. A prospective randomized study of the elective surgical treatment for duodenal ulcer: two-to-ten-year follow-up study. Surgery. 1973 Feb;73(2):256–260. [PubMed] [Google Scholar]
  9. Jaffe B. M., Newton W. T., Judd D. R., Ballinger W. F., 2nd Surgical management of recurrent peptic ulcers. Am J Surg. 1969 Feb;117(2):214–221. doi: 10.1016/0002-9610(69)90306-7. [DOI] [PubMed] [Google Scholar]
  10. NUBOER J. F. Recurrent ulceration after surgical treatment of gastro-duodenal peptic ulcer. Ann R Coll Surg Engl. 1961 May;28:303–320. [PMC free article] [PubMed] [Google Scholar]
  11. Pederson R. A., Brown J. C. Inhibition of histamine-, pentagastrin-, and insulin-stimulated canine gastric secretion by pure "gastric inhibitory polypeptide". Gastroenterology. 1972 Mar;62(3):393–400. [PubMed] [Google Scholar]
  12. Sirinek K. R., Cataland S., O'Dorisio T. M., Mazzaferri E. L., Crockett S. E., Pace W. G. Augmented gastric inhibitory polypeptide response to intraduodenal glucose by exogenous gastrin and cholecystokinin. Surgery. 1977 Oct;82(4):438–442. [PubMed] [Google Scholar]
  13. Stabile B. E., Passaro E., Jr Recurrent peptic ulcer. Gastroenterology. 1976 Jan;70(1):124–135. [PubMed] [Google Scholar]
  14. Stuart M., Hoerr S. O. Recurrent peptic ulcer following primary operations with vagotomy for duodenal ulcer. Results of surgical treatment in 42 patients. Arch Surg. 1971 Aug;103(2):129–132. doi: 10.1001/archsurg.1971.01350080045006. [DOI] [PubMed] [Google Scholar]
  15. Thompson J. E., Dailey T. H. Recurrent ulceration after operation for peptic ulcer: results after gastroenterostomy, gastrectomy and vagotomy in 64 cases. Ann Surg. 1966 May;163(5):704–712. doi: 10.1097/00000658-196605000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. WALTERS W., REMINE W. H. APPRAISAL OF THE VARIOUS OPERATIONS FOR PEPTIC ULCER. Surgery. 1964 Apr;55:585–594. [PubMed] [Google Scholar]
  17. Waddell W. R., Loughry R. W. Gastric acid secretion after pancreaticoduodenectomy. Arch Surg. 1968 Apr;96(4):574–585. doi: 10.1001/archsurg.1968.01330220090016. [DOI] [PubMed] [Google Scholar]
  18. Warren K. W., Poulantzas J. K., Kune G. A. Life after total pancreatectomy for chronic pancreatitis: clinical study of eight cases. Ann Surg. 1966 Nov;164(5):830–834. doi: 10.1097/00000658-196611000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Wychulis A. R., Priestley J. T., Foulk W. T. A study of 360 patients with gastrojejunal ulceration. Surg Gynecol Obstet. 1966 Jan;122(1):89–99. [PubMed] [Google Scholar]
  20. du Plessis D. J., Mieny C. J. Stomal ulceration complicating the "triple anastomosis" operation for carcinoma of the head of the pancreas. S Afr J Surg. 1972 Jun;10(2):125–127. [PubMed] [Google Scholar]

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