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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.

A Russian stapler and an EEA stapler were used for end-to-end anastomosis of the canine descending colon. The vascular structures of the anastomotic sites were investigated for postoperative changes at two, three, four, five, and six weeks after anastomosis by using the resin-casting method, with a scanning electron microscope. The two techniques of anastomotic stapling led to the following differences: at two weeks or more following anastomosis, it was found that, compared with the EEA stapler, the site stapled with the Russian device showed a slightly more markedly irregular microvascular pattern of the capillary network in the mucosal membranes along the anastomotic suture line and what were believed to be microulcerations as well. Samples of the Russian stapler at two and three weeks postoperatively showed that the fault zones had developed in the vascular casts of the mucosal capillary system between the area of irregular vasculature and the normal mucosa. It was clearly established, however, that the microvascular channels in the mucosal membrane of the anastomotic site across the orad and anad segments of the colon had already formed after two weeks with both of the stapling techniques. New microvessels grew within a range of about 10 mu in diameter from the cut-off surface of the mucosa and united. No necrotic destruction of tissue or deficiency findings had manifested themselves in the inverted cuff zone of the anastomotic site, and the staple had been enveloped by the blood vessels of the submucosal layer and embedded in the intestinal wall during the period of two to six weeks. New microvessels, 10 to 15 mu in diameter, were found to have already formed in the two-week samples, passing vertically across the lumen of the closed eye of the staple, and no differences in vascular structure were detected, depending on the different shapes of staples used. Five to six weeks after the anastomotic surgery, the mucosal membranes in the anastomotic site showed a normal vascular structure with only minute residual indentations.

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