Alimentary Tract Reconstruction following Pancreatoduodenectomy: A New Method with Improvements in the Nutritional State and Gastrointestinal Hormone Release in Dogs.

Abstract

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 an 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 smaller in the new method, and the frequency of both morbidity and mortality was lower. Although perforated stomal ulcer was observed in one dog after the Child's method, no peptic ulcer was detectable after our method. The integrated increase of plasma triglyceride in response to ingested butter was slightly greater in our method than in the Child's. At six weeks after surgery, plasma concentrations of both cholecystokinin and secretin, not only during fasting but after intake of butter, were augmented in both groups, particularly in the group receiving the new method. These results indicate that retaining the remaining upper small intestine as the food pathway is effective in maintaining good nutritional state, and in facilitating the release of gastrointestinal hormones.dog ; pancreatoduodenectomy ; alimentary tract reconstruction ; cholecystokinin ; secretin The typical pancreatoduodenectomy procedure involves a massive resection of the digestive organs in the upper abdomen : the resection of the distal stomach, the duodenum, the upper jejunum, the gallbladder and the bile duct together with the head of the pancreas. As a result, a number of undesirable consequences, such as maldigestion of nutrients, glucose intolerance and disturbances in bone metabolism have been brought about (Miyata et al. 1974;Sato et al. 1986;Yagi et al.