Procedures of Gastrointestinal Reconstruction After Panceatico-Duodenectomy and Exocrine Panceatic Function of the Remnant Pancreas

Yamashita, Yuichi; Kasahara, Kogoro; Tenmoku, Sumio; Miyata, Michio; Morioka, Yasuhiko

doi:10.5833/jjgs.14.1594

Cited by 3 publications

(3 citation statements)

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“…Attempts to evaluate gastrointestinal function after pancreatico‐duodenectomy by measuring plasma secretin concentration have been reported previously 12,13. However, as only a trace amount of secretin is present in blood, and inhibitory factors in the blood affect the reliability of the assay, only recently has it become possible to evaluate minute postprandial changes in secretin concentration.…”

Section: Discussionmentioning

confidence: 99%

“…Yamashita et al,12 using hydrochloric acid stimulation and a conventional immunoreactive assay method, found that the plasma secretin response was better in Whipple‐treated patients given a digestive tract reconstruction that allowed for the passage of food through the jejunum. Further, Inoue et al14 have reported that serum cholecystokinin and pancreatic polypeptide responses to meal loading are better in Whipple‐treated patients given a gastrointestinal tract reconstruction that allows for the direct passage of food through the upper jejunum, in contrast to reconstructions that exclude the upper jejunum.…”

Section: Discussionmentioning

confidence: 99%

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Postprandial plasma secretin response in Whipple-treated patients

Takada

Yasuda

Watanabe

et al. 1996

J Hep Bil Pancr Surg

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We hypothesize that the presence of a few secretin-releasing cells sited in the upper jejunum may provoke a postprandial secretin response to meal loading in patients who have undergone the Whipple procedure. This procedure involves gastrectomy and total duodenectomy and requires gastrointestinal tract reconstruction by one of three methods: (i) choledocho-pancreatico-gastro alignment (PD-1), (ii) pancreatico-choledocho-gastro alignment (PD-2) (both these methods excluding the upper jejunum from the route of food passage), or (iii) gastro-pancreatico-choledocho alignment (PD-3), in which food passes through the upper jejunum. Fasting and postprandial plasma secretin and gastrin response were measured in 47 Whipple-treated patients, 16 given a PD-1, 15 given a PD-2, and 16 given a PD-3, and in 15 healthy controls. Plasma secretin response and integrated secretin release were higher, but not significantly, in the PD-3 group, and lower in all three Whipple-treated groups than in the control (P < 0.05). Plasma gastrin concentration showed no significant increase in any of the three treated groups and was significantly lower than in the controls (P < 0.05). The integrated gastrin release also did not differ among the treated groups and was lower than in the controls (P < 0.05). Twenty-four-h monitoring showed that the gastric pH was neutral or alkaline in all three treated groups. The failure to prove our hypothesis may be due to the presence of too few secretin-releasing cells in the upper jejunum to respond to the meal loading and/or to the intragastric pH not being sufficiently acidic to stimulate those secretin-releasing cells present in the upper jejunum.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Postprandial plasma secretin response in Whipple-treated patients

Takada

Yasuda

Watanabe

et al. 1996

J Hep Bil Pancr Surg

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“…In 1960, Imanaga devised a new reconstruction method where the remaining stomach was anastomosed to the upper jejunum in the Billroth-I type to preserve the function of the liver and pancreas, and both the bile and pancreatic ducts were anastomosed directly to the upper jejunum in an end-to-side fashion. Yamashita et al (1981) interposed the uppermost part of the remaining jejunum, 40 cm in length, between the remaining stomach and the Roux-en-Y loop of the jejunum, and reported that the pancreatic exocrine secretion was preserved well. After Traverso and Longmire (1978) devised the pylorus-preserving procedure, several modifications have been done on the method (Flautner et al 1985; Kim et al 1987;Takada et al 1989).…”

Section: Discussionmentioning

confidence: 99%

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

Imamura¹,

Yamauchi²,

Kakizaki³

1991

Tohoku J. Exp. Med.

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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.

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