Evaluation of pylorus-preserving pancreatoduodenectomy with the Imanaga reconstruction by hepatobiliary and gastrointestinal dual scintigraphy

Background: Following pylorus-preserving pancreatoduodenectomy (PPPD), most surgeons use gastrointestinal reconstruction with an end-to-side duodenoje junostomy placed distally to the pancreatojejunostomy and choledochojejunos tomy. In contrast, the authors have consistently used PPPD with the Imanaga reconstruction (PPPD-Imanaga) which consists of end-to-end duodenojejunost omy, end-to-side pancreatojejunostomy and choledochojejunostomy, performed in that order. In this study, the movement of bile and food after PPPD-Iman aga was evaluated to document the functional advantages of this method. Methods: Twenty-four patients who had undergone PPPD-Imanaga were subjected to hepatobiliary and gastrointestinal dual scintigraphy. The interval betw een operation and scintigraphy ranged from 28 days to 67 months. Six of the 24 patients underwent repeated dual scintigraphy for the observation of te mporal changes in gastrointestinal function. Results: The incidence of biliogastric reflux and bile stasis in the jejuna l loop was markedly decreased at times later than 2 months after operation. Delay of gastric emptying and bile evacuation, sometimes accompanied by st asis in the jejunal loop, affected the mixing status of bile and food at Ih after the beginning of imaging. A majority of the patients, how ever, had a satisfactory mixing status at 2 h. Conclusion: The Imanaga reconstruction appears to be a recommendable proced ure following PPPD, in light of the bile and food movement-achieved in the gastrointestinal tract.