Experimental Study on the Effect of Hepatectomy on Local Hemodynamics in the Pancreaticojejunal Anastomotic Region

Kouichi Kubota

Department of Surgery, Tokyo Women's Medical College Daini Hospital

To evaluate the effect of hepatectomy on pancreaticojejunal anastomosis, we examined local hemodynamics in the anastomotic region in experimental models. Seventeen adult mongrel dogs were treated with 40% hepatectomy plus pancreaticojejunostomy (hepatectomy group) and eight were treated with pancreaticojejunostomy alone (nonhepatectomy group). Mortality was 55.8% in the hepatectomy group and 12.8% in the non-hepatectomy group (p<0.05). Macroscopically, more small abscesses were present (p<0.05), and histologically, changes tended to remain in the stage of hemorrhage and necrosis in the anastomotic region in the hepatectomy group. The pancreatic hydroxyproline level was more markedly elevated in the non-hepatectomy group (p<0.05). Portal hemodynamics: pressure was elevated, while blood flow and PO₂ were reduced in the hepatectomy group (p<0.01). Local hemodynamics in the anastomotic region: tissue blood flow and tissue PO₂, were reduced on the pancreatic side in the hepatectomy and non-hepatectomy groups. On the jejunal side, tissue blood flow and tissue PO₂ were as markedly reduced in the hepatectomy group (p<0.01). The above findings suggest that, if hepatectomy is combined with pancreaticojejunostomy, protracted portal stasis occurs to induce congestion and impairment of the microcirculation on the jejunal side of the anastomosis. This, together with circulatory disturbance on the pancreatic side, causes a delay in wound healing that can lead to suture failure at the site of anastomosis.

Key words
simultaneous excision of liver and pancreas, portal hemodynamics, local circulation, suture failure, wound healing

Reprint requests
Kouichi Kubota Department of Surgery, Tokyo Women's Medical College Daini Hospital
2-1-10 Nishioku, Arakawa-ku, Tokyo, 116 JAPAN

Accepted
June 14, 1993

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