Comparative studies of plasma secretin response after reconstructive surgery of the stomach and pancreas

The postprandial plasma secretin response was examined in ten normal persons, seven patients with a Billroth I and seven with a Billroth II anastomosis after subtotal gastrectomy, seven with a Roux-en-Y anastomosis, two with an interposed jejunal anastomosis, and five with a modified Child's anastomosis after pancreatoduodenectomy. The postprandial plasma secretin response in patients with Billroth I anastomosis was better than that in patients with a Billroth II anastomosis but was less than that of normal subjects. Although no postprandial secretin response was noted in Roux-en-Y anastomosis after total gastrectomy, a response was seen in patients with the interposed jejunal anastomosis because the digested food passed through the duodenum, but it was less than that for Billroth I and II patients and normal controls. After a modified Child's reconstruction, the postprandial secretin response was similar to that of patients with the Billroth II, which preserved the duodenum. A patient with a modified Child's reconstruction was examined 12 years after surgery and had the same response as other patients with the modified Child's reconstruction and those with a Billroth II anastomosis within 2 months after surgery. After ingestion of hydrochloride solution, the plasma secretin release in patients with a Billroth I and II anastomosis after subtotal gastrectomy and Roux-en-Y anastomosis after total gastrectomy had a better response than after a meal, but this was less than in normal subjects. The authors suggest that careful selection of intestine for the gastrointestinal anastomosis, which contains many secretin secretory cells, is important to obtain endogenous secretin release. For gastrojejunostomy after pancreatoduodenectomy, a method preserving the pylorus is better than the usual gastrojejunostomy because it maintains gastric acid. The ingestion of secretin stimulants, such as hydrochloride, may help to prevent pancreatic dysfunction after gastrectomy and other surgical reconstructions.