G. Naritomi et al., PANCREATIC HEAD RESECTION WITH AND WITHOUT PRESERVATION OF THE DUODENUM - DIFFERENT POSTOPERATIVE GASTRIC-MOTILITY, Surgery, 120(5), 1996, pp. 831-837
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.