Evaluation of pylorus-preserving pancreatoduodenectomy with the Imanaga reconstruction by hepatobiliary and gastrointestinal dual scintigraphy.
BACKGROUND
Following pylorus-preserving pancreatoduodenectomy (PPPD), most surgeons use gastrointestinal reconstruction with an end-to-side duodenojejunostomy placed distally to the pancreatojejunostomy and choledochojejunostomy. In contrast, the authors have consistently used PPPD with the Imanaga reconstruction (PPPD-Imanaga) which consists of end-to-end duodeno- jejunostomy, end-to-side pancreatojejunostomy and choledochojejunostomy, performed in that order. In this study, the movement of bile and food after PPPD-Imanaga was evaluated to document the functional advantages of this method.


METHODS
Twenty-four patients who had undergone PPPD-Imanaga were subjected to hepatobiliary and gastrointestinal dual scintigraphy. The interval between operation and scintigraphy ranged from 28 days to 67 months. Six of the 24 patients underwent repeated dual scintigraphy for the observation of temporal changes in gastrointestinal function.


RESULTS
The incidence of biliogastric reflux and bile stasis in the jejunal loop was markedly decreased at times later than 2 months after operation. Delay of gastric emptying and bile evacuation, sometimes accompanied by stasis in the jejunal loop, affected the mixing status of bile and food at 1 h after the beginning of imaging. A majority of the patients, however, had a satisfactory mixing status at 2 h.


CONCLUSIONS
The Imanaga reconstruction appears to be a recommendable procedure following PPPD, in light of the bile and food movement achieved in the gastrointestinal tract.
Hishinuma
S
S
Department of Surgery, Tochigi Cancer Center, Yohnan, Utsunomiya, Japan.
Ogata
Y
Y
Matsui
J
J
Ozawa
I
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D001646:Bile / Q000502:physiology; D005260:Female; D006801:Humans; D007205:Indium Radioisotopes; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D004369:Pentetic Acid; D011708:Pylorus; D011877:Radionuclide Imaging
D007205:Indium Radioisotopes; D004369:Pentetic Acid