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Predictive Factors for Exocrine Pancreatic Insufficiency After Pancreatoduodenectomy with Pancreaticogastrostomy

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

The aim of this study was to determine risk factors for exocrine pancreatic insufficiency after pancreatoduodenectomy (PD) with pancreaticogastrostomy (PG).

Material and Methods

A 13C-labeled mixed triglyceride breath test was performed in 61 patients after PD to assess exocrine pancreatic function. Percent 13CO2 cumulative dose at 7 h <5% was considered diagnostic of exocrine pancreatic insufficiency. Abdominal computed tomography scans were utilized to assess the dilatation of the main pancreatic duct (MPD dilatation) in the remnant.

Results

Thirty-eight of 61 patients (62.3%) were diagnosed with exocrine pancreatic insufficiency. Univariate analysis identified significant associations between two preoperative factors (preoperative impaired endocrine function and a hard pancreatic texture induced by preexisting obstructive pancreatitis), plus one postoperative factor (MPD dilatation caused by PG stricture) and exocrine pancreatic insufficiency (P < 0.05). Multivariate analysis determined that all three of these factors were independent factors (P < 0.05).

Conclusions

Although exocrine pancreatic insufficiency after PD may be partly explainable by preexisting obstructive pancreatitis prior to surgery, surgeons desiring to obtain better postoperative exocrine pancreatic function after PD would be well-advised to devote considerable attention to preventing PG stricture.

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Authors and Affiliations

  1. Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Hiroyuki Nakamura, Yoshiaki Murakami, Kenichiro Uemura, Yasuo Hayashidani, Takeshi Sudo, Hiroki Ohge & Taijiro Sueda

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  1. Hiroyuki Nakamura
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  2. Yoshiaki Murakami
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  3. Kenichiro Uemura
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  4. Yasuo Hayashidani
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  6. Hiroki Ohge
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  7. Taijiro Sueda
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Correspondence to Hiroyuki Nakamura.

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Nakamura, H., Murakami, Y., Uemura, K. et al. Predictive Factors for Exocrine Pancreatic Insufficiency After Pancreatoduodenectomy with Pancreaticogastrostomy. J Gastrointest Surg 13, 1321–1327 (2009). https://doi.org/10.1007/s11605-009-0896-5

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  • DOI: https://doi.org/10.1007/s11605-009-0896-5

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