title: Functional and morphological changes in pancreatic remnant after pancreaticoduodenectomy.
abstract: OBJECTIVE
  Pancreatic exocrine insufficiency has been reported to be more common in pancreaticogastrostomy (PG) than in pancreaticojejunostomy (PJ) after pancreaticoduodenectomy (PD). This study aimed to evaluate the long-term outcome after PD between these 2 groups.
  
  
  METHODS
  We evaluated the long-term functional status of 42 surviving patients diagnosed with periampullary lesions who underwent PJ or PG after PD and followed up for more than 1 year. Among these, 23 patients underwent PJ and 19 patients underwent PG. To compare the 2 groups, we analyzed the (1) pancreatic exocrine insufficiency by questioning the presence or absence of steatorrhea, (2) pancreatic endocrine function by measuring glycohemoglobin A1c, fasting blood glucose, and history of new-onset diabetes, (3) nutritional status by measuring serum total protein, albumin, cholesterol, and triglyceride, (4) gastric emptying time, (5) panendoscopic findings, (6) changes of pancreatic duct diameter by computed tomography, and (7) relaparotomy rate.
  
  
  RESULTS
  The mean follow-up time for PG and PJ were 37 +/- 23 and 103 +/- 52 months, respectively (P < 0.05). A total of 52.4% patients developed pancreatic exocrine insufficiency, and 11.9% had new-onset diabetes. There was no significant difference between PJ and PG groups. A significantly improved postoperative nutritional state regarding serum total protein and albumin were noticed in both groups. There was no significant difference in terms of gastric emptying time, positive panendoscopic findings, and changes in pancreatic duct diameter. The pancreatic remnant-related relaparotomy rate was higher in the PJ group as compared with the PG group (17.4% vs 0%; P = 0.056).
  
  
  CONCLUSIONS
  There is no significant difference in pancreatic exocrine or endocrine insufficiency, gastric emptying time, and positive panendoscopic findings between PJ and PG. Pancreaticojejunostomy was associated with a higher pancreatic remnant-related relaparotomy rate; however, because of a shorter follow-up in the PG group, a continuous long-term follow-up is still needed.
authors: Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors: Wen-Liang
authors: WL
authors: Fang
authors: Cheng-Hsi
authors: CH
authors: Su
authors: Yi-Ming
authors: YM
authors: Shyr
authors: Tien-Hua
authors: TH
authors: Chen
authors: Rheun-Chuan
authors: RC
authors: Lee
authors: Ling-Chen
authors: LC
authors: Tai
authors: Chew-Wun
authors: CW
authors: Wu
authors: Wing-Yiu
authors: WY
authors: Lui
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001786:Blood Glucose / Q000378:metabolism; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D003920:Diabetes Mellitus / Q000209:etiology; D004379:Duodenal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D010188:Exocrine Pancreatic Insufficiency / Q000097:blood / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007515:Islets of Langerhans / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D046790:Pancreas, Exocrine / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy / Q000009:adverse effects*; D045602:Steatorrhea / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human