Upper jejunal motility after pancreatoduodenectomy according to the type of anastomosis, pancreaticojejunal or pancreaticogastric

• Published in: Journal of the American College of Surgeons Vol. 188; no. 3; pp. 261 - 270
• Main Authors: Le Blanc-Louvry, Isabelle, Ducrotté, Philippe, Peillon, Christophe, Testart, Jacques, Denis, Philippe, Michot, Francis, Tenière, Paul
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.1999; Elsevier Science; American College of Surgeons
• Subjects: Aged; Anastomosis, Surgical - adverse effects; Anastomosis, Surgical - methods; Biological and medical sciences; Female; Gastrointestinal Motility; Humans; Jejunum - physiopathology; Jejunum - surgery; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Manometry; Medical sciences; Middle Aged; Myoelectric Complex, Migrating; Pancreas - physiopathology; Pancreas - surgery; Pancreaticoduodenectomy - adverse effects; Pancreaticoduodenectomy - methods; Stomach - physiopathology; Stomach - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Human; Postoperative; Stomach; Duodenum; Surgical anastomosis; Mobility; Jejunum; Dysfunction; Surgery; Disease of the small intestine; Pancreas; Comparative study; Pancreaticojejunal; Pancreatoduodenectomy
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/S1072-7515(98)00309-3

Background: The goal of this study was to compare upper jejunal motor patterns after Billroth II pancreatoduodenectomy according to the type of pancreatic anastomosis (pancreaticojejunostomy [PJA] or pancreaticogastrostomy [PGA]) and the presence or absence of postoperative symptoms. Study Design: Manometric recordings during fasting and after a 750-kcal meal were performed in the afferent limb in 12 patients (7 PJA, 5 PGA) and in the efferent limb in 15 other patients (7 PJA, 8 PGA) with a postoperative delay of 15 ± 6 days and 3.9 ± 2.2 months respectively. Patient data were compared to those of 20 healthy controls. Results: During fasting, the 2 main abnormal findings were a higher incidence (p < 0.05) and a slower migration velocity (p < 0.01) of incomplete phase III by comparison with that recorded in controls. No difference for phase III was observed between the 2 surgical procedures regardless of recording site. Trimebutine, 100 mg intravenously, induced a phase III in 89% (24 of 27) of the patients. Delay of motor response varied from 5 to 10 minutes without difference between the recording site; it was less than 2 minutes in 100% of controls. Trimebutine-induced phase III showed similar propagation abnormalities to the spontaneous phase III. Duration of the fed pattern (p < 0.001) and motor index (p < 0.001) were significantly lower than in controls after the meal, in both limbs, whatever the type of anastomosis. Differences between the 2 surgical procedures were a slower migration velocity of phase III (p < 0.01) and a lower postmeal motor index (p < 0.05) in the efferent limb after PJA than after PGA. Nine of 27 patients were symptomatic. In these 9 patients, mean phase III migration velocity was slower (p < 0.001), and mean area under the postprandial curve was higher (p < 0.01) than in asymptomatic patients. Propagated clusters of contractions were only found in symptomatic patients and in the afferent limb. Conclusions: Pancreatoduodenectomy is associated with significant motor disturbances, mainly slower phase III and a reduced fed pattern, in the upper jejunum, at least during the first 3 postoperative months. Few motor differences were observed between PGA and PJA pancreatic anastomosis. A lesser occurrence of postsurgical motor anomalies does not appear to be an argument for preferring PGA to PJA.