Obstructed pancreaticojejunostomy partly explains exocrine insufficiency after pancreatic head resection
| Autor: | Sari Räty, Mickael Parviainen, Isto Nordback, Juhani Sand, Anneli Piironen |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
Adult
Male medicine.medical_specialty Pancreatic disease Time Factors Cholangiopancreatography Magnetic Resonance Anastomosis Gastroenterology Pancreatic head Resection Feces Pancreatectomy Postoperative Complications Internal medicine Pancreaticojejunostomy medicine Humans Aged Aged 80 and over medicine.diagnostic_test Pancreatic Elastase business.industry Magnetic resonance imaging Middle Aged medicine.disease Prognosis Diarrhea medicine.anatomical_structure Exocrine Pancreatic Insufficiency Female medicine.symptom Pancreas Complication business Follow-Up Studies |
| Zdroj: | Scandinavian journal of gastroenterology. 42(2) |
| ISSN: | 0036-5521 |
| Popis: | The majority of patients with long-term survival after pancreatic head resection suffer from pancreatic exocrine insufficiency. The objective of this study was to investigate whether this is due to glandular malfunction or obstructed pancreaticojejunal anastomosis.Twenty-six patients (10 M, 16 F, mean age 61 years, range 34-81 years) were re-examined a median of 52 months (range 3-76 months) after pancreatic head resection and end-to-end invaginated pancreaticojejunostomy. Pancreatic exocrine function was measured by fecal elastase-1 assay. The size of the pancreatic remnant, glandular secretion and the flow through the anastomosis were analyzed with secretin-stimulated dynamic magnetic resonance pancreatography (D-MRP).All patients had pancreatic exocrine insufficiency, 24 (92%) of them having severe insufficiency. Eighteen patients (69%) reported moderate to severe diarrhea. Lowest fecal elastase-1 concentrations were associated with the initial diagnosis of chronic pancreatitis or ductal adenocarcinoma, suggesting preoperative primary or secondary chronic pancreatitis as important determinants. The size of the remnant gland did not correlate with the fecal elastase-1 concentrations. D-MRP failed in three patients. Severe glandular malfunctions were found in 7 (30%) of the 23 successful D-MRP examinations. The anastomosis was totally obstructed in 5 patients (22%) or partially obstructed in 6 (26%) but remained perfectly open in 5 patients (22%). The five patients with perfect anastomoses had the highest measured median fecal elastase-1 activity.Although late diarrhea and pancreatic exocrine insufficiency may be partly induced already by the disease treated with resection, at least half may be explained by obstructed anastomosis. To obtain better late functional results, improvements may be required in the surgical techniques. |
| Databáze: | OpenAIRE |
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