Functional and morphological changes in the pancreatic remnant following pancreaticoduodenectomy with pancreaticogastric anastomosis

Background: The aim was to evaluate pancreatic exocrine and endocrine funct ion, pancreatic atrophy and main pancreatic duct dilatation in the pancreat ic remnant following pancreaticoduodenectomy and pancreaticogastrostomy. Methods: Nineteen patients who underwent pancreaticoduodenectomy and pancre aticogastrostomy for benign or malignant pancreatic tumours with a histolog ically normal pancreatic resection margin were studied prospectively. The m edian interval between operation and evaluation was 32 (range 12-120) month s. Pancreatic exocrine insufficiency was assessed by measuring 72-h faecal fat concentrations and faecal-1 elastase. Fasting blood glucose, haemoglobi n A1c, serum peptide C and insulin levels were used to assess endocrine fun ction. Pancreatic parenchymal thickness and main pancreatic duct diameter w ere measured before operation and at evaluation using computed tomography ( CT). Results: Faecal fat excretion was raised in 16 of 17 patients; faecal-1 ela stase was reduced in all 17 patients. None of the 17 non-diabetic patients had developed diabetes mellitus at follow-up. A significant decrease in pan creatic parenchymal thickness and increased dilatation of the main pancreat ic duct were observed on CT at evaluation (P = 0.01 and P = 0.01 respective ly). Pancreatic atrophy, assessed by subtracting the diameter of the pancre atic duct from the total gland thickness, tended to develop over time, but at the limit of statistical significance (P = 0.06). Conclusion: A median of 3 years following pancreaticoduodenectomy and pancr eaticogastrostomy, patients remained free from diabetes but developed marke d pancreatic exocrine insufficiency.