Upper jejunal motility after pancreatoduodenectomy according to the type of anastomosis, pancreaticojejunal or pancreaticogastric

Background: The goal of this study was to compare upper jejunal motor patte rns after Billroth II pancreatoduodenectomy according to the type of pancre atic anastomosis (pancreaticojejunostomy [PJA] or pancreaticogastrostomy [P GA]) and the presence or absence of postoperative symptoms. Study Design: Manometric recordings during fasting and after a 750-kcal mea l were performed in the afferent limb in 12 patients (7 PJA, 5 PGA) and in the efferent limb in 15 other patients (7 PJA, 8 PGA) with a postoperative delay of 15 +/- 6 days and 3.9 +/- 2.2 months respectively. Patient data we re compared to those of 20 healthy controls. Results: During fasting, the 2 main abnormal findings were a higher inciden ce (p < 0.05) and a slower migration velocity (p < 0.01) of incomplete phas e III by comparison with that recorded in controls. No difference for phase III was observed between the 2 surgical procedures regardless of recording site. Trimebutine, 100 mg intravenously, induced a phase III in 89% (24 of 27) of the patients. Delay of motor response varied from 5 to 10 minutes w ithout difference between the recording site; it was less than 2 minutes in 100% of controls. Trimebutine-induced phase III showed similar propagation abnormalities to the spontaneous phase III. Duration of the fed pattern (p < 0.001) and motor index (p < 0.001) were significantly lower than in cont rols after the meal, in both limbs, whatever the type of anastomosis. Diffe rences between the 2 surgical procedures were a slower migration velocity o f phase III (p < 0.01) and a lower postmeal motor index (p < 0.05) in the e fferent limb after PJA than after PGA. Nine of 27 patients were symptomatic . In these 9 patients, mean phase III migration velocity was slower (p < 0. 001), and mean area under the postprandial curve was higher (p < 0.01) than in asymptomatic patients. Propagated clusters of contractions were only fo und in symptomatic patients and in the afferent limb. Conclusions: Pancreatoduodenectomy is associated with significant motor dis turbances, mainly slower phase III and a reduced fed pattern, in the upper jejunum, at least during the first 3 postoperative months. Few motor differ ences were observed between PGA and PJA pancreatic anastomosis. A lesser oc currence of postsurgical motor anomalies does not appear to be an argument for preferring PGA to PJA. (J Am Cell Surg 1999; 188:261-270. (C) 1999 by t he American College of Surgeons).