THE EFFECTS OF MAJOR ABDOMINAL-SURGERY, ENTERAL AND PARENTERAL-NUTRITION ON PANCREATIC FUNCTION AND MORPHOLOGY

The effects of major abdominal surgery and nutritional support upon pa ncreatic function and morphology were studied in similar groups of pat ients who underwent major abdominal surgery (n = 18), received parente ral nutritional support (n = 18) or received enteral nutritional suppo rt (n = 16). The exocrine function of the pancreas was measured by mea ns of an oral pancreatic function test (using 1 g of N-benzoyl-L-tyros yl para-aminobenzoic acid) with measurement of serum para-aminobenzoic acid at 3 h and the Pancreatic Excretion Index. Pancreatic morphology was assessed by real time ultrasound and a pancreatic size index was calculated (maximum diameter of head x body). Serial measurements of f unction and morphology were carried out in each patient at entry into the study and at 7 and 14 days after operation or start of nutritional support. Serum PABA levels were similar in the 3 groups at the start of the study. Although the levels remained unchanged in the enteral an d parenteral groups, a significant and progressive decrease was observ ed in the surgical group (serum PAPA = 27.5 nmol/l (24.0-30.6) before operation, 10.5 nmol/l (5.5-13.4) 14 days after operation, P < 0.01). No significant changes in pancreatic size were seen. Parenteral and en teral nutrition preserves pancreatic exocrine function. A dramatic red uction in pancreatic exocrine function is seen after major abdominal s urgery.