# Preservation of the pylorus in pancreaticoduodenectomy

Source: https://onco.cc/key-papers/paper-traverso-longmire-pylorus-preservation-pancreaticoduodenectomy-sgo-1978/  
OnCo record `paper-traverso-longmire-pylorus-preservation-pancreaticoduodenectomy-sgo-1978` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The 1978 report of two patients in whom the surgeons kept the stomach outlet intact during the Whipple operation, the modification most surgeons now use.

## Summary

Traverso and Longmire, Surgery, Gynecology and Obstetrics, June 1978, pages 959 to 962. The indexed abstract is the authors' own caution: further clinical observation and laboratory evaluation would be needed before recommending the modification, which preserves the pylorus and distal stomach in patients resected for benign disease or carcinoma of the distal duodenum, but the early results in the two patients described were encouraging. Their 1980 follow-up in Annals of Surgery extended the series to 18 patients, eight evaluated in detail an average of six months after surgery: every patient had marked pancreatic insufficiency on laboratory testing, 88 percent described normal bowel movements and 25 percent reported weight loss, and all required intensive pancreatic enzyme replacement.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: pancreatic-evidence
- Journal: Surgery, Gynecology and Obstetrics
- Year: 1978
- Authors: Traverso LW, Longmire WP.
- Findings: Two patients; pylorus and distal stomach preserved during pancreaticoduodenectomy.; The authors called for further observation before recommending the modification.; In the 1980 follow-up of 18 patients, all showed pancreatic insufficiency on testing and all required intensive enzyme replacement.
- What it means: The pylorus-preserving Whipple became the standard variant, and the 1980 follow-up is an early record of the exocrine insufficiency that still goes untreated in most patients today.
- Caveats: Two patients with benign or duodenal disease, not pancreatic cancer.; No DOI is indexed for the 1978 paper; the PubMed record is the anchor.

## Sources

- PubMed: https://pubmed.ncbi.nlm.nih.gov/653575/
- Follow-up evaluation, 18 patients (Ann Surg 1980): https://doi.org/10.1097/00000658-198009000-00005
- PubMed: https://pubmed.ncbi.nlm.nih.gov/7416828/

## Connected records

- key papers: [Enzyme replacement improves survival among patients with pancreatic cancer: Results of a population based study](https://onco.cc/key-papers/paper-roberts-pert-survival-pancreatic-cancer-pancreatology-2019/), [Treatment of carcinoma of the ampulla of Vater](https://onco.cc/key-papers/paper-whipple-carcinoma-ampulla-of-vater-ann-surg-1935/)
- cancers: [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/resectable-pdac/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/), [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- terms: [Whipple procedure (pancreaticoduodenectomy)](https://onco.cc/terms/whipple/)
- roadmaps: [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/)
- ideas: [Pancreatic enzyme replacement by default: prescribe at diagnosis, audit the rate, and run the trial that settles survival](https://onco.cc/ideas/idea-pdac-enzyme-replacement-prescribing-by-default/)

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