GALLBLADDER MOTILITY AFTER DUODENUM-PRESERVING RESECTION OF THE HEAD OF THE PANCREAS

Background: Duodenum-preserving resection of the head of the pancreas (DPRHP) is performed in patients with chronic painful pancreatitis (CP ) localized in the head of the pancreas. It has been suggested that fu nctional integrity of the upper digestive tract is preserved after DPR HP. We tested this hypothesis with regard to gallbladder motility. Met hods: Gallbladder motility and cholecystokinin (CCK) secretion were st udied fasting, after cephalic vagal stimulation with sham feeding, and after regular feeding in 9 patients after DPRHP, in 6 unoperated pati ents with CP, and 9 healthy control subjects. Results: Mean fasting ga llbladder volume in patients after DPRHP (49 +/- 10 cm(3)) and patient s with CP (53 +/- 10 cm(3)) was larger than in controls (33 +/- 3 cm(3 )). Sham-feeding-stimulated gallbladder contraction did not differ bet ween patients after DPRHP, patients with CP, and controls. Both postpr andial CCK secretion and gallbladder contraction in patients after DPR HP (78 +/- 16 pM . 120 min; 47% +/- 6%) and patients with CP (72 +/- 1 8 pM . 120 min; 40% +/- 7%) were significantly reduced (P < 0.05) comp ared with controls (151 +/- 13 pM . 120 min; 74% +/- 4%). Fasting gall bladder volume, sham feeding, and regular-feeding-induced gallbladder contraction and postprandial CCK secretion did not differ between oper ated and unoperated patients with CP. Conclusions: Gallbladder motilit y and CCK secretion are reduced in patients with pancreatic insufficie ncy. A DPRHP procedure does not further influence these results. These findings support the concept that gallbladder motor function is prese rved after DPRHP.