Alimentary Tract Reconstruction Following Pancreatoduodenectomy -A New Method with Improvements in Digestive and Absorptive Functioning, and in Gut Hormone Release in Dogs-

Mikio Imamura, Hidemi Yamauchi

Department of Surgery, Sendai National Hospital

Experiments were performed on adult beagle dogs to investigate the nutritional state and the release of gastrointestinal hormones after pancreatoduodenectomy. A new variation of reconstruction of the alimentary tract was devised and compared with the classical Child's method. In our method, the remaining stomach was anastomosed to the oral stump of the jejunum in end-to-end fashion. A short mid-intestinal segment was interposed between the pancreatic and bile ducts and the upper jejunum. During the observation period of six months after surgery, the loss of body weight was significantly lower after the new method, and the frequency of both morbidity and mortality was lower. A stomal ulcer was detectable in a dog receiving the Child's method, but not in any treated by our method. The integrated increase in plasma triglyceride in response to ingested butter was slightly greater after our method than Child's. Six weeks after surgery, plasma CCK and secretin levels, not only at fasting but after ingestion of butter, were augmented in both groups, particularly in the group receiving the new method. Six months after surgery, plasma levels of both CCK and secretin in the two groups tended to return to preoperative levels, though their integrated responses to butter were still higher after our method. Therefore, it is considered that retaining the remaining upper small intestine as the main food pathway is very effective for the digestion and absorption of nutrients and for the release of gastrointestinal hormones.

Key words
pancreatoduodenectomy, alimentary tract reconstruction, nutrition, gastrointestinal hormone release

Reprint requests
Mikio Imamura Department of Surgery, Sendai National Hospital
2-8-8 Miyagino, Miyagino-ku, Sendai, 983 JAPAN

Accepted
October 9, 1991

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