Effect of surgery for chronic pancreatitis on pancreatic function: pancreatico-jejunostomy and duodenum-preserving resection of the head of the pancreas.
BACKGROUND
Resection and drainage procedures are performed for chronic pancreatitis. After resection, pancreatic function deteriorates; however, little is known about the effect of drainage procedures.


METHODS
Pancreatic function was evaluated prospectively before and after surgery in 27 patients with duodenum-preserving resection of the head of the pancreas (DPRHP), and in 12 patients with pancreatico-jejunostomy (P-JS); 18 patients with chronic pancreatitis served as controls. Results of the 2 groups were not compared because of differences in patient characteristics and indications for surgery. Endpoints were exocrine function (fecal fat excretion, urinary PABA recovery), endocrine function (oral glucose tolerance test, serum C-peptide concentrations), and pancreatic polypeptide secretion.


RESULTS
Groups were not different with respect to age and duration of symptoms. Median urinary PABA recovery was not altered significantly after surgery: DPRHP, from 40% to 31%; P-JS, from 52% to 44%; and controls, from 43% to 48%. Median fecal fat also did not change significantly: DPRHP, from 6 to 12 g/24 h; P-JS, from 9 to 5 g/24 h; and controls, from 6 to 7 g/24 h. Although the integrated blood glucose value did not change after DPRHP, the integrated serum C-peptide value decreased after DPRHP (P<.02). After P-JS, the integrated blood glucose value decreased (P<.02), but there was no change in integrated serum C-peptide secretion. Neither integrated blood glucose nor C peptide values were affected in controls. Insulin dependency increased (22% to 33%) after DPRHP. Pancreatic polypeptide secretion decreased only after DPRHP (P=.003).


CONCLUSIONS
Surgery for chronic pancreatitis does not influence exocrine pancreatic function after either a drainage (P-JS) or a resection procedure (DPRHP). Clinical endocrine function is not affected after DPRHP but improves after P-JS.
Maartense
Stefan
S
Department of Gastroenterology and Hepatology, Leiden University Medical Center, Amsterdam, The Netherlands.
Ledeboer
Michael
M
Bemelman
Willem A
WA
Ringers
Jan
J
Frolich
Marjike
M
Masclee
Ad A M
AA
D001786:Blood Glucose; D002908:Chronic Disease; D004322:Drainage; D004386:Duodenum / Q000601:surgery*; D006801:Humans; D007515:Islets of Langerhans / Q000502:physiology* / Q000601:surgery; D008875:Middle Aged; D010179:Pancreas / Q000502:physiology* / Q000601:surgery; D010193:Pancreaticojejunostomy; D010195:Pancreatitis / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome
D001786:Blood Glucose