[Natural history of the pancreatic stump after duodenopancreatectomy of the pancreatic head].
Major complications following pancreaticoduodenectomy are thought to be chiefly associated with exocrine secretion of the pancreatic remnant which is not well known. This work aims to assess the exocrine secretion of the pancreatic remnant within the early post-operative period.


METHODS
Seventy-five patients undergoing pancreaticoduodenectomy for presumed tumour were included in a prospective multicentre study. A tube was inserted in the pancreatic duct at the time of construction of the pancreatic anastomosis. Peripancreatic drainage was routinely used. Pancreatic juice and peripancreatic drainage fluid were collected and measured and pancreatic enzyme monitored. For 7 days patients received total parenteral nutrition and continuous infusion of randomly Somatostatin 14 (S-14) at a dose of 6 mg/24 h (days 1-6) and 3 mg/24 h (day 7) or matching placebo. Pancreatic fistula was defined as a daily drainage of more than 100 cc of amylase-rich fluid after day 3, persisting after day 12 or associated with symptoms or needing specific treatment.


RESULTS
Daily output of pancreatic juice was low during the first postoperative day and then increased gradually until day 5. A high enzyme concentration was observed in pancreatic juice on the first post-operative day. S-14 infusion resulted in a significant decrease of both pancreatic fistula rate and enzyme concentration in peripancreatic fluid.


CONCLUSIONS
During the first postoperative days, the outflow of the exocrine secretion of the pancreatic remnant is low but contains a high enzyme concentration with significant leaks within the peripancreatic area. S-14 infusion results in a decrease of pancreatic juice leaks from the pancreatic remnant.
Gouillat
C
C
Services de chirurgie, Hôtel-Dieu, 1, place de l'hôpital, 69288 Lyon, France. christian.gouillat@chu-lyon.fr
Faucheron
J L
JL
Balique
J G
JG
Gayet
B
B
Saric
J
J
Partensky
C
C
Baulieux
J
J
Chipponi
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000681:Amylases / Q000032:analysis / Q000097:blood; D004322:Drainage; D006801:Humans; D007262:Infusions, Intravenous; D008049:Lipase / Q000032:analysis / Q000097:blood; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000188:drug therapy* / Q000201:enzymology / Q000209:etiology*; D010189:Pancreatic Juice / Q000737:chemistry / Q000187:drug effects / Q000201:enzymology; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010289:Parenteral Nutrition, Total; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D013004:Somatostatin / Q000627:therapeutic use*; D016896:Treatment Outcome
D013004:Somatostatin; D008049:Lipase; D000681:Amylases