ESTIMATION OF FAT-ABSORPTION WITH THE C-13-TRIOCTANOIN BREATH TEST AFTER PANCREATICODUODENECTOMY OR PANCREATIC HEAD RESECTION

The aim of this study was to determine if fat absorption is better aft er pylorus-presenting pancreatoduodenectomy (PPPD) or duodenum-preserv ing pancreatic head resection (DPPHR) compared with that following pan creatoduodenectomy with gastrectomy (SPD), provided the patients have similar pancreatic exocrine function. Fat absorption was studied using the C-13-trioctanoin breath test in patients who were grouped accordi ng to the degree of fibrosis of the pancreatic remnant. The latter was judged by histologically measuring the fibrosis in a transectional we dge of resected pancreas, We evaluated 11 SPD cases, 25 PPPD cases, an d 9 DPPHR cases. The C-13 excretion rates and cumulative excretion val ues following DPPHR or PPPD were significantly better than those follo wing SPD. The C-13 excretion rates and cumulative values for the patie nts with > 30% fibrosis of the pancreas were lower than those in patie nts with < 30% pancreatic fibrosis, regardless of the surgical procedu re, The cumulative value in the SPD group, however, was lower than tha t in the PPPD or DPPHR patients with < 30% pancreatic fibrosis. The re sults suggested that fat absorption following PPPD or DPPHR is superio r to that after SPD in patients with the same fibrotic area of the pan creatic remnant and depends on the degree of fibrosis in the pancreati c remnant.