PANCREATIC HEAD RESECTION WITH AND WITHOUT PRESERVATION OF THE DUODENUM - DIFFERENT POSTOPERATIVE GASTRIC-MOTILITY

Background. Early gastric stasis is a unique complication of pylorus-p reserving pancreatoduodenectomy. Because the duodenum proved to be imp ortant in the initiation and consolidation of phase III activity of th e migrating motor complex of the stomach, the absence of the duodenum and hence gastric phase III may be a cause of gastric stasis. Methods. Postoperative gastrointestinal motility was measured with a pneumohyd raulic capillary infusion system in nine patients who had undergone py lorus-preserving pancreatoduodenectomy through an indwelling tube asse mbly placed at operation and compared with that in six patients who ha d undergone duodenum-preserving pancreatic head resection. Plasma moti lin concentrations were measured by radioimmunoassay. Results. The mea n period until the first occurrence of gastric phase III was significa ntly longer in patients who had undergone a pylorus-preserving pancrea toduodenectomy (40.6 +/- 4.6 days or more) than in patients who had un dergone a duodenum-preserving pancreatic head resection (18.8 +/- 4.3 days; p < 0.05). On the day of the first observation of gastric phase III, the plasma concentration of motilin at proximal jejunal phase III in patients who underwent a pylorus-preserving pancreatoduodenectomy (50.2 +/- 9.8 pg/ml) was significantly lower than that at duodenal pha se III in patients who underwent a duodenum-preserving pancreatic head resection (184.6 +/- 48.6 pg/ml; p < 0.05). Conclusions. Gastric stas is after a pylorus-preserving pancreatoduodenectomy may be in part att ributable to the low concentration of plasma motilin caused by the res ection of the duodenum.