Pancreatic fibrosis correlates with delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy with pancreaticogastrostomy

Abstract

Objective: To show that residual pancreatitis delays gastric emptying, the authors used surgical specimens and studied gastric stasis after pylorus-preserving pancreaticoduodenectomy (PPPD).

Summary background data: Delayed gastric emptying is a leading cause of complications after PPPD, occurring in 30% of patients. The pathogenesis of delayed gastric emptying remains unclear.

Methods: Surgical specimens of the pancreas from 25 patients undergoing PPPD and pancreaticogastrostomy were collected and examined by microscopy according to progressive pancreatic fibrosis and divided into three groups: no fibrosis, periductal fibrosis, and intralobular fibrosis. The authors then measured gastric output from the nasogastric tube, pancreatic output from the pancreatic tube, and the time until patients tolerated a solid diet.

Results: Pancreatic juice output was significantly related to the degree of pathologic findings, and gastric output was inversely related to them. A significant prolongation of postoperative solid diet tolerance correlated with increased pancreatic fibrosis and gastric fluid production.

Conclusions: Pancreatic fibrosis and increased gastric fluid production correlate with delayed gastric emptying after PPPD with pancreaticogastrostomy.

Figures

Figure 1. Our gastrointestinal reconstruction after pylorus-preserving pancreaticoduodenectomy. Nasogastric tube drainage was needed for as little as 5 postoperative days, and transhepatic catheters were used to drain pancreatic juice for 21 postoperative days.

Figure 2. Surgical specimens of the pancreas in the three groups (hematoxylin and eosin, ×40). (A) No fibrosis group. Pancreatic edema and a few inflammatory cell infiltrations into the parenchyma of the pancreas are shown. (B) Periductal fibrosis group. Periductal fibrosis and many inflammatory cell infiltrations are seen. (C) Intralobular fibrosis group. Acinar necrosis, lobular fibrosis, and inflammatory cell infiltrations are seen.

Figure 3. Pancreatic juice output and gastric output in the three groups. Progressive pancreatic fibrosis by histology was significantly associated with decreased pancreatic juice production and increased gastric output. NF, no fibrosis group; PF, periductal fibrosis group; IF, intralobular fibrosis group.

Figure 4. Time until a solid diet was tolerated in the three groups. There was a significant prolongation of postoperative solid diet toleration in both the periductal and intralobular fibrosis groups versus both the no fibrosis group. NF, no fibrosis group; PF, periductal fibrosis group; IF, intralobular fibrosis group.