Obstructed pancreaticojejunostomy partly explains exocrine insufficiency after pancreatic head resection

Abstract

Although late diarrhea and pancreatic exocrine insufficiency may be partly induced already by the disease treated with resection, at least half may be explained by obstructed anastomosis. To obtain better late functional results, improvements may be required in the surgical techniques.

Partial Pancreatic Resection for Pancreatic Malignancy Is Associated with Sustained Pancreatic Exocrine Failure and Reduced Quality of Life: A Prospective Study

“…In our series, pancreato-gastrostomy was avoided and there was no correlation between the type of surgical resection or type of tumour and PEI, although the number of patients was small. Nordback et al [15] stated that all 26 patients had PEI at a median of 52 months (range 3–76) after pancreatic head resection and pancreato-jejunostomy with the most profound deficiency in patients with chronic pancreatitis or secondary obstructive chronic pancreatitis due to ductal adenocarcinoma. There was partial or total anastomotic obstruction in 11 (48%) of 23 cases with postoperative imaging, but the whole study was based on FE-1 analysis making interpretation difficult.…”

“…These studies have confirmed high levels of pancreatic exocrine insufficiency (PEI) postoperatively, which required enzyme supplementation. Studies which have assessed pancreatic exocrine function following surgery for pancreatic tumours have focussed on the type of pancreatic anastomosis, postoperative imaging, and risk factors [15,18,19,20]. The follow-up times for these studies have been variable and the majority have not performed QoL analyses [19,21].…”

“…The most frequently described change of pancreatic exocrine function after resectional surgery is steatorrhoea [9], which is defined as a stool fat content of >7 g/day (when diet contains 100 g of fat) with associated symptoms of abdominal pain, flatus and weight loss [10]. Malabsorption of fat occurs when pancreatic lipase and trypsin falls to below 5–10% of normal production [11], although the mechanisms [9,12,13,14,15,16] resulting in intraluminal pancreatic enzyme deficiency are multiple and overlapping (summarized in fig. 1).…”

“…Overall, the exact incidence of PEI after recovery from pancreatic resection for tumour of the pancreas and whether it is sustained is not clear [15]. Extended resections are much more likely to leave patients with severe PEI.…”

Lateral Pancreatogastrostomy for Stenotic Pancreatojejunostomy After Pancreatoduodenectomy: A Case Report

“…Better choice of adjuvant therapy has also improved survival in small number of patients. Early complications after pancreaticoduodenectomy (PD) are well studied as well as well defined by International Study Group on Pancreatic Fistula [3][4][5][6].…”