GASTRIC-EMPTYING FOLLOWING PYLORUS-PRESERVING WHIPPLE AND DUODENUM-PRESERVING PANCREATIC HEAD RESECTION IN PATIENTS WITH CHRONIC-PANCREATITIS

BACKGROUND: After pylorus-preserving Whipple (PPW), delayed gastric em ptying (DGE) is reported in up to 50% of these patients. We analyzed g astric emptying and hormonal adaptation of cholecystokinin (CCK), panc reatic polypeptide (PR), and gastrin following two surgical procedures for chronic pancreatitis (CP): the PPW and the duodenum-preserving pa ncreatic head resection (DPPHR). METHODS: Ten patients underwent DPPHR and 10 underwent PPW for CP. Preoperatively and 10 days and 6 months postoperatively, gastric emptying (paracetamol absorption test) and CC K, gastrin, and PP were measured using a test meal stimulation. RESULT S: The area under the serum paracetamol time curve for 0 to 120 minute s (AUG) showed no preoperative difference. Ten days postoperatively, t he AUC was significantly reduced (P <0.05) after PPW but not after DPP HR. Six months postoperatively, AUC was comparable with the preoperati ve findings in DPPHR and PPW. The integrated 180-minute PP release was significantly reduced 10 days and 6 months postoperatively in both gr oups. The integrated 180-minute CCK release was decreased 10 days afte r PPW, but failed to be significant (P = 0.053), Gastrin levels were p ostoperatively unchanged. CONCLUSION: Following DPPHR we found no dela y in gastric emptying. In contrast, DGE occurs early after PPW. Our da ta may help explain the slower recovery in PPW patients with regard to weight gain and relief from pain, which may be due to the functional alteration of gastric emptying and motility after this type of surgery . (C) 1997 by Excerpta Medica, Inc.