Experimental Studies on the Gastric Functions of Exocrine and Endocrine System after Duodenectomy with Preservation of the Stomach and Duodenal Bulb

Seiichi Ono

The First Department of Surgery, Juntendo University School of Medicine (Director: Prof. Noburu Sakakibara)

In order to elucidate the cause of stomal ulcer, one of the complications associated with pancreatoduodenectomy, an investiagation was experimentally carried out to determine the relationship of exo- and endocrine gastric functions to the extent of preservation of the duodenal bulb after duodenectomy with preservation of the stomach and the duodenal bulb (preservative surgery). After the preservative surgery, the basal acid output, maximum acid output and insulin acid output were markedly increased , by 216.7%, 50.3% and 108.5%, respectively, when 1 cm of the duodenal bulb was preserved, while when 3 cm of the duodenal bulb was preserved, the changes were negligible, 5.5%, 3.0% and 1.9%, respectively, that is, as the extent of preservation of the duodenal bulb increased, the rate of increase in gastric acid secretion decreased. Secretin was present in a high concentration in the distal part 2 to 10 cm removed from the pyloric ring. These findings suggest that the postoperative increase in gastric acid secretion as due to the disruption of the duodenal brake. Further more, when 3 cm of the duodenal bulb was preserved, functions of physiological exo- and endocrine gastric secretion were retained. This finding indicates that the occurrence of postoperative stomal ulcers can be prevented by preserving the duodenal bulb to this extent.

Key words
duodenectomy with preservation of the stomach and duodenal bulb, gastric functions, stomal ulcer, secretin in the duodenal and small intestinal mucosa

Reprint requests
Seiichi Ono The First Department of Surgery, Juntendo University School of Medicine
2-1-1 Hongo, Bunkyo-ku, Tokyo, ll3 JAPAN

Accepted
February 14, 1990

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