Postprandial Plasma Gastrin and Secretin Concentrations After a Pancreatonduodenectomy

Abstract

Based on the observation that patients given a pylorus-preserving pancreatoduodenectomy maintain higher gut hormonal levels than do patients who have received the classic Whipple surgical procedure, which seems most likely due to a postoperative difference in the remaining digestive tract, the postprandial plasma gastrin and secretin concentrations in patients who have received either surgery have been evaluated to examine this difference more fully. The subjects were 20 patients treated by a pylorus-preserving operation and 27 patients treated by the Whipple procedure whose concentrations were compared with those of 8 healthy control patients. The postprandial plasma gastrin concentrations were found to be similar in patients given the pylorus-preserving operation and the controls and were significantly lower in patients who underwent the Whipple procedure (p less than 0.05). Similarly, the postprandial plasma secretin concentrations did not differ in these two groups, whereas patients who underwent the Whipple procedure showed significantly lower concentrations at 60, 90, and 120 minutes (p less than 0.05). The above findings, as well as supportive data in the literature, indicate that the duodenal bulb and the gastric antrum, which are resected in the Whipple procedure and are kept in the pylorus-preserving operation, seem to play important roles in the gut hormonal release and that the pylorus-preserving operation is the superior surgical technique in terms of gastrin and secretin release.

Pancreaticojejuno Anastomosis after Pancreaticoduodenectomy: Brief Pathophysiological Considerations for a Rational Surgical Choice

“…Moreover, reduced (but significant) amounts of CCK and secretin are released postprandially even after pancreaticoduodenectomy, suggesting a compensatory mechanism of the remnant of the upper small intestine: in fact, after the duodenum, the upper jejunum is the second most important source of release of CCK and secretin [23, 24]. …”

Die Wertigkeit der pyloruserhaltenden partiellen Duodenopankreatektomie beim duktalen Pankreascarcinom

“…In der Tat zeigen funktionelle Untersuchungen nach pyloruserhaltender partieller Duodenopankreatektomie von Hunt und McLean, daû diese Magenentleerungssto È rungen zeitlich begrenzt sind und mo È glicherweise durch das nicht unerhebliche chirurgische Trauma ausgelo È st wurden [8]. [17]. Die Autoren stellten fest, daû im Gegensatz zu Patienten nach PD-Operation, die postprandialen Gastrin-und Sekretinwerte bei Patienten mit einem pyloruserhaltenden resektiven Verfahren im Normbereich waren.…”

Surgery for Carcinoma of the Pancreas in Japan

“…One such modified approach is pylorus-preserving pancreatoduodenectomy with extended lymph node dissection and either connective tissue dissection or portal vein resection or both [20, 30, 31]. Compared with conventional pancreatoduodenectomy, which is associated with partial gastrectomy, pylorus-preserving pancreatoduodenectomy is advantageous in terms of the physiological condition of the patient, allowing sufficient food intake to sustain body weight maintenance and gut hormone release [32]. For patients with low-grade malignancies such as mucin-producing pancreatic tumors, several types of organ-preserving pancreatectomy have been developed in Japan, including duodenum-preserving total pancreatic head resection [12, 13, 33], ventral pancreatectomy that allows maximal preservation of pancreatic tissue and regional anatomy which adequately resects low-grade malignancies within the ventral segment of the pancreas [34, 35].…”