The effects of major abdominal surgery, enteral and parenteral nutrition on pancreatic function and morphology.
The effects of major abdominal surgery and nutritional support upon pancreatic function and morphology were studied in similar groups of patients who underwent major abdominal surgery (n = 18), received parenteral nutritional support (n = 18) or received enteral nutritional support (n = 16). The exocrine function of the pancreas was measured by means of an oral pancreatic function test (using 1 g of N-benzoyl-L-tyrosyl para-aminobenzoic acid) with measurement of serum para-aminobenzoic acid at 3 h and the Pancreatic Excretion Index. Pancreatic morphology was assessed by real time ultrasound and a pancreatic size index was calculated (maximum diameter of head x body). Serial measurements of function and morphology were carried out in each patient at entry into the study and at 7 and 14 days after operation or start of nutritional support. Serum PABA levels were similar in the 3 groups at the start of the study. Although the levels remained unchanged in the enteral and parenteral groups, a significant and progressive decrease was observed in the surgical group (serum PABA = 27.5 nmol/l (24.0-30.6) before operation, 10.5 nmol/l (5.5-13.4) 14 days after operation, P < 0.01). No significant changes in pancreatic size were seen. Parenteral and enteral nutrition preserves pancreatic exocrine function. A dramatic reduction in pancreatic exocrine function is seen after major abdominal surgery.
Sagar
P
P
Scarborough Hospital, Scalby Road, Scarborough, North Yorkshire, UK.
Wai
D
D
Poon
P
P
Macfie
J
J
Mitchell
C
C