Abstract
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.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Braasch J. W., Deziel D. J., Rossi R. L., Watkins E., Jr, Winter P. F. Pyloric and gastric preserving pancreatic resection. Experience with 87 patients. Ann Surg. 1986 Oct;204(4):411–418. doi: 10.1097/00000658-198610000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chey W. Y., Lee Y. H., Hendricks J. G., Rhodes R. A., Tai H. H. Plasma secretin concentrations in fasting and postprandial state in man. Am J Dig Dis. 1978 Nov;23(11):981–988. doi: 10.1007/BF01263096. [DOI] [PubMed] [Google Scholar]
- Itani K. M., Coleman R. E., Meyers W. C., Akwari O. E. Pylorus-preserving pancreatoduodenectomy. A clinical and physiologic appraisal. Ann Surg. 1986 Dec;204(6):655–664. doi: 10.1097/00000658-198612000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pearlman N. W., Stiegmann G. V., Ahnen D. J., Schultz A. L., Fink L. M. Acid and gastrin levels following pyloric-preserving pancreaticoduodenectomy. Arch Surg. 1986 Jun;121(6):661–664. doi: 10.1001/archsurg.1986.01400060055006. [DOI] [PubMed] [Google Scholar]
- Shiratori K., Watanabe S., Takeuchi T. [Radioimmunoassay of secretin with special reference to the sensitivity of the method]. Nihon Shokakibyo Gakkai Zasshi. 1983 Jul;80(7):1475–1479. [PubMed] [Google Scholar]
- Sudo T., Ishiyama K., Kawamura M., Tsubakimoto R., Shobu R., Takemoto M., Shono K., Umemura H., Shiraha S., Kuyama T. Changes in plasma gastrin and secretin levels after pancreaticoduodenectomy. Surg Gynecol Obstet. 1984 Feb;158(2):133–136. [PubMed] [Google Scholar]
- Traverso L. W., Longmire W. P., Jr Preservation of the pylorus in pancreaticoduodenectomy a follow-up evaluation. Ann Surg. 1980 Sep;192(3):306–310. doi: 10.1097/00000658-198009000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Traverso L. W., Longmire W. P., Jr Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet. 1978 Jun;146(6):959–962. [PubMed] [Google Scholar]
- Watanabe S., Shiratori K., Takeuchi T. [Radioimmunoassay of secretin using ethanol extraction method of plasma--significant increase of plasma secretin concentrations after a meal in a man (author's transl)]. Nihon Shokakibyo Gakkai Zasshi. 1981 Oct;78(10):1920–1928. [PubMed] [Google Scholar]
- Whipple A. O. Pancreaticoduodenectomy for Islet Carcinoma : A Five-Year Follow-Up. Ann Surg. 1945 Jun;121(6):847–852. doi: 10.1097/00000658-194506000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Whipple A. O., Parsons W. B., Mullins C. R. TREATMENT OF CARCINOMA OF THE AMPULLA OF VATER. Ann Surg. 1935 Oct;102(4):763–779. doi: 10.1097/00000658-193510000-00023. [DOI] [PMC free article] [PubMed] [Google Scholar]