Fat absorption after pylorus-preserving pancreatoduodenectomy reconstructed with Billroth II pancreaticojejunostomy or Billroth I pancreaticogastrostomy

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.