P J Thor1, A Matyja, T Popiela, Z Szybinski, B Huszno, J Sobocki. 1. 1st General and GI Surgery Clinic, Department of Pathophysiology, Collegium Medicum, Jagiellonian University, Krakow, Poland. mfthor@cyf-kr.edu.pl
Abstract
BACKGROUND/AIMS: The main concern about pylorus preserving pancreatectomy (PPP) is delayed gastric emptying (GE). Both cancer and surgical procedures cause damage to the enteric nervous system and induce profound changes in gastric motility and emptying. The aim was to evaluate the effects of primary disease and type of surgical procedure used (standard pancreatoduodenectomy, SP vs. PPP) on myoelectric activity (MA), and solid and liquid GE in pancreatectomy patients. METHODOLOGY: Twenty-eight subjects were included, 18 after Whipple (group A) and 10 after a Traverso (group B) procedure. MA was captured by cutaneous electrodes (Synectics) and simultaneously LGE tested with ultrasonography. On separate days, the SGE of a radiolabelled meal was measured. MA and GE studies were done before and within three months after surgery. RESULTS: Before surgery LGE/SGE were delayed in 5/8 patients in group A and 2/2 in group B. Gastric dysrhythmia was observed in 6 patients in group A and 1 in group B. After PPP, the nasogastric tube was removed within 8.4+/-4.9 days and after SP within 4.6+/-4.1 days. GE studies showed accelerated LGE/SLG in 16/12 and delayed in 6/5 patients, respectively, in group A and B. Dysrhythmia was observed in 16 patients in group A and in 4 in group B. There was a strong relationship between SGE delay and dysrhythmia in patients after PPP. CONCLUSIONS: We conclude that papilla of Vater neoplasia damages mechanisms responsible for gastric emptying to a lesser extent than pancreatic cancer. In patients after PPP, post-operative MA disturbances are partially responsible for delayed GE.
BACKGROUND/AIMS: The main concern about pylorus preserving pancreatectomy (PPP) is delayed gastric emptying (GE). Both cancer and surgical procedures cause damage to the enteric nervous system and induce profound changes in gastric motility and emptying. The aim was to evaluate the effects of primary disease and type of surgical procedure used (standard pancreatoduodenectomy, SP vs. PPP) on myoelectric activity (MA), and solid and liquid GE in pancreatectomy patients. METHODOLOGY: Twenty-eight subjects were included, 18 after Whipple (group A) and 10 after a Traverso (group B) procedure. MA was captured by cutaneous electrodes (Synectics) and simultaneously LGE tested with ultrasonography. On separate days, the SGE of a radiolabelled meal was measured. MA and GE studies were done before and within three months after surgery. RESULTS: Before surgery LGE/SGE were delayed in 5/8 patients in group A and 2/2 in group B. Gastric dysrhythmia was observed in 6 patients in group A and 1 in group B. After PPP, the nasogastric tube was removed within 8.4+/-4.9 days and after SP within 4.6+/-4.1 days. GE studies showed accelerated LGE/SLG in 16/12 and delayed in 6/5 patients, respectively, in group A and B. Dysrhythmia was observed in 16 patients in group A and in 4 in group B. There was a strong relationship between SGE delay and dysrhythmia in patients after PPP. CONCLUSIONS: We conclude that papilla of Vater neoplasia damages mechanisms responsible for gastric emptying to a lesser extent than pancreatic cancer. In patients after PPP, post-operative MA disturbances are partially responsible for delayed GE.