Duodenum-preserving total pancreatectomy for end stage chronic XXXX .

@entity1 @entity788 @entity11448 @entity6
The classical Whipple procedure for chronic @entity788 has been associated with significant long term postoperative morbidity. The pylorus-preserving procedure of Longmire has reduced but not eliminated the long-term morbidity. Preservation of the whole duodenum with total pancreatectomy has been introduced for the treatment of @entity1 with end-stage chronic @entity788 after favourable experience with this procedure in @entity1 for @entity11448 . Fourteen @entity1 with chronic @entity788 have had a total pancreatectomy with preservation of the duodenum and the bile duct. All @entity1 are still alive (median follow-up 9.5 months) and none suffered major complications in the perioperative period. One @entity1 developed a biliary stricture at 3 months, requiring biliary reconstruction. Six of the @entity1 have returned to full-time work; nine require no analgesia. All @entity1 require pancreatic enzyme replacement, and all @entity1 have gained weight postoperatively. @entity6 control is satisfactory with a twice daily insulin regime. Duodenum-preserving total pancreatectomy is feasible in the adult without mortality or high morbidity; early experience suggests that preserving the duodenum improves gastrointestinal function with easier control of the @entity6 .
