Fat absorption after pylorus-preserving pancreatoduodenectomy reconstructed with Billroth II pancreaticojejunostomy or Billroth I pancreaticogastrostomy
S. Miyakawa et al., Fat absorption after pylorus-preserving pancreatoduodenectomy reconstructed with Billroth II pancreaticojejunostomy or Billroth I pancreaticogastrostomy, HEP-GASTRO, 47(31), 2000, pp. 264-268
BACKGROUND/AIMS: The aim of this study was to determine whether Billroth I
pancreaticogastrostomy (PG-I) or Billroth II pancreaticojejunostomy (PJ-II)
after pylorus-preserving pancreatoduodenectomy is associated with better p
ostoperative fat absorption, based on residual pancreatic exocrine function
. Several reconstructive operations have been employed after pylorus-preser
ving pancreatoduodenectomy to maximize postoperative nutrition. However, no
single-institution study has been published comparing the reconstructive p
rocedures with respect to digestion and absorption of fat.
METHODOLOGY: Fat absorption was studied using the C-13-trioctanoin breath t
est in patients who were grouped according to the degree of fibrosis of the
pancreatic remnant, which was determined by histologic examination of the
resection specimen. The fibrosis was graded: grade 0, <10% fibrosis; grade
1, 10-30% fibrosis; and grade 2, >30% fibrosis. There were 22 patients in t
he PG-I group and 22 patients in the PJ-II group.
RESULTS: There were no significant differences between the PG-I and PJ-II g
roups in the cumulative excretion of labeled carbon dioxide in the patients
with grade 0 pancreatic fibrosis. The cumulative excretion in the PG-I gro
up was better than in the PJ-II group in the patients with grade 1 and grad
e 2 pancreatic fibrosis.
CONCLUSIONS: Fat absorption after PG-I is superior to that; after PJ-II in
patients with disordered exocrine function of the pancreatic remnant. Billr
oth I pancreaticogastrostomy allows more effective utilization of the exocr
ine enzymes of the pancreatic remnant due to elimination of the blind loop
characteristic of the Billroth II pancreaticojejunostomy.