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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2015; 21(19): 5794-5804
Published online May 21, 2015. doi: 10.3748/wjg.v21.i19.5794
Pathophysiology after pancreaticoduodenectomy
Chang Moo Kang, Jin Ho Lee
Chang Moo Kang, Jin Ho Lee, Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul 120-752, South Korea
Chang Moo Kang, Jin Ho Lee, Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul 120-752, South Korea
Author contributions: Kang CM designed research and wrote the paper; and Lee JH contributed to the data acquisition and performed research.
Conflict-of-interest: Chang Moo Kang and Jin Ho Lee have nothing to disclose about this review.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chang Moo Kang, MD, PhD, Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Sinchon-dong Seodaemoon-gu, Seoul 120-752, South Korea. cmkang@yuhs.ac
Telephone: +82-2-22282135 Fax: +82-2-3138289
Received: November 22, 2014
Peer-review started: November 23, 2014
First decision: January 22, 2015
Revised: February 25, 2015
Accepted: April 17, 2015
Article in press: April 17, 2015
Published online: May 21, 2015
Processing time: 179 Days and 6.1 Hours
Abstract

Pancreaticoduodenectomy (PD) will result in removal of important multiorgans in upper intestinal tract and subsequently secondary physiologic change. In the past, surgeons just focused on the safety of surgical procedure; however, PD is regarded as safe and widely applied to treatment of periampullary lesions. Practical issues after PD, such as, effect of duodenectomy, metabolic surgery-like effect, alignment effect of gastrointestinal continuity, and non-alcoholic fatty liver disease were summarized and discussed.

Keywords: Pancreaticoduodenectomy; Delayed gastric emptying; Metabolic surgery; Exocrine insufficiency; Fatty liver; Postoperative pancreatic fistula

Core tip: In the past, pancreaticoduodenectomy (PD) should be avoided because of its extremely high morbidity and mortality. With the advance of surgical techniques and perioperative management, PD has been regarded as good choice for the treatment of periampullary pathologic conditions. In this moment, turning our interest to potential physiological change following PD may be necessary, because PD always results in removal of important internal organs in upper gastrointestinal tract and altering normal path of gastrointestinal flow. Well awareness of these “internal” changes will be helpful for proper management of the patients with PD.