In vivo evaluation of long-term patency of pancreaticoenterostomy after Whipple operation.
OBJECTIVE
The aim of this study was to examine the long-term patency of pancreaticoenterostomy in vivo.


METHODS
Evaluation of the patency of the pancreaticoenterostomy was conducted in 12 patients who had undergone the Whipple procedure. After intravenous infusion of secretin (1 microgram/kg), the diameter of the pancreatic duct was taken at 1, 3, 5, 15, 20 and 25 min by means of ultrasonography. We estimated the degree of anastomotic stricture by the maximal dilatation ratio [MDR: Maximal value (Dmax)/basal value (D0)]. The patients underwent pancreatic exocrine function tests before and 1-2 years after surgery.


RESULTS
Maximal ductal dilatation was noted from 3 min of 15 min after secretin infusion, thereafter ductal diameter gradually diminished and returned to its basal value at 25 min. Maximal dilatation ratio ranged from 1.3-2.5, 1.7 +/- 0.12. There was a good negative relationship between the maximal dilatation ratio and pancreatic exocrine function. Based on the result of chi 2 analysis, we judged anastomotic stricture to be present in 2 patients with maximal dilatation ratio above 2.0. In these 2 patients, preoperative pancreatic exocrine function recoveries were 69 and 48%, while postoperative pancreatic exocrine function recoveries were 13.8 and 18%, respectively. In the other 10 patients, there was no difference between preoperative and postoperative value of pancreatic exocrine function.


CONCLUSIONS
The present method permits safe and non-invasive evaluation of the patency of pancreaticoenterostomy.
Second Department of Surgery, Kinki University School of Medicine, Osaka, Japan.
N
N
Hashimoto
H
H
Fujiwara
H
H
Nomura
H
H
Ohyanagi
D010129:4-Aminobenzoic Acid / Q000652:urine; D000368:Aged; D003251:Constriction, Pathologic; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000473:pathology*; D010186:Pancreatic Function Tests; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy; D012633:Secretin; D016896:Treatment Outcome; D014463:Ultrasonography
D012633:Secretin; D010129:4-Aminobenzoic Acid