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World J Gastrointest Oncol. Sep 15, 2014; 6(9): 325-329
Published online Sep 15, 2014. doi: 10.4251/wjgo.v6.i9.325
Considerations on pancreatic exocrine function after pancreaticoduodenectomy
Francisco José Morera-Ocon, Luis Sabater-Orti, Elena Muñoz-Forner, Jaime Pérez-Griera, Joaquín Ortega-Serrano
Francisco José Morera-Ocon, Luis Sabater-Orti, Elena Muñoz-Forner, Joaquín Ortega-Serrano, Department of General Surgery, Hospital Clinico de Valencia, 46010 Valencia, Spain
Jaime Pérez-Griera, Clinical Analysis Laboratory, Hospital Clinico de Valencia, 46010 Valencia, Spain
Author contributions: Morera-Ocon FJ and Sabater-Oti L wrote and designed the manuscript; Muñoz-forner E and Ortega-Serrano J were also involved in editing the manuscript; Pérez-Griera J performed the lab analysis and described the analytical methods.
Correspondence to: Francisco José Morera-Ocon, PhD, Department of General Surgery, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010 Valencia, Spain. fmoreraocon@aecirujanos.es
Telephone: +34-96-3862600 Fax: +34-96-3392015
Received: August 14, 2013
Revised: September 25, 2013
Accepted: November 15, 2013
Published online: September 15, 2014
Processing time: 401 Days and 10.1 Hours
Abstract

The pancreaticoduodenectomy (PD) procedure may lead to pancreatic exocrine and endocrine insufficiency. There are several types of reconstruction for this kind of operation. Pancreaticogastrostomy (PG) was introduced to reduce the rate of postoperative pancreatic fistula. Although some randomized control trials have shown no differences regarding pancreatic leakage between PG and pancreaticojejunostomy (PJ), recently some reports reveal benefits from the PG over the PJ. Some surgeons concern about the performing of the PG and inactivation of pancreatic enzymes being in contact with the gastric juice, and the detrimental results over the exocrine pancreatic function. The pancreatic exocrine function can be measured with direct and indirect tests. Direct tests have the highest sensitivity and specificity for detection of exocrine insufficiency but require tube placement. Among the tubeless indirect tests, the van de Kamer stool fat analysis remains the standard to diagnose fat malabsorption. The patient compliance and time consuming makes it not so suitable for its clinical use. Fecal immunoreactive elastase test is employed for screening of exocrine insufficiency, is not cumbersome, and has been used to study pancreatic function after resection. We analyze the FE1 levels in our patients after the PD with two types of reconstruction, PG and PJ, and we discuss some considerations about the pancreaticointestinal drainage method after pancreaticoduodenectomy.

Keywords: Pancreaticoduodenectomy; Pancreaticogastrostomy; Pancreaticojejunostomy; Pancreatic exocrine function; Fecal elastase

Core tip: Many patients present pancreatic exocrine insufficiency after pancreatic resection. Exocrine insufficiency leads to steatorrhoea, flatulence, abdominal pain, weight loss and malnutrition. Extent of resection will determine the severity of insufficiency, but also changes in anatomy may be determining factors. Pancreatogastrostomy is deemed detrimental over the pancreatic function because of the hypothetical inactivation of pancreatic enzymes due to the acid juice of the stomach. In this review we discuss the physiological aspects of the changes in exocrine pancreatic function focusing on the pancreatoenterostomy after a pancreaticoduodenectomy.