Comparison of the functional and morphological changes in pancreas after pancreaticoduodenectomy undergoing modified duct to mucosa (Buchler) and binding PJ (Pengs)- a randomised control study with additional retrospective data

Dr. S. Soundappan; Dr. R. Pradeep; Dr. Ranjith; Dr. Shrikant; Dr. Shrishil; Dr. Suresh Babu

Dr. S. Soundappan Department of Gastroenterology, Asian Institute of Gastroenterology (AIG), 6-3-661, Somajiguda, Hyderabad, India
Dr. R. Pradeep Department of Gastroenterology, Asian Institute of Gastroenterology (AIG), 6-3-661, Somajiguda, Hyderabad, India
Dr. Ranjith Department of Gastroenterology, Asian Institute of Gastroenterology (AIG), 6-3-661, Somajiguda, Hyderabad, India
Dr. Shrikant Department of Gastroenterology, Asian Institute of Gastroenterology (AIG), 6-3-661, Somajiguda, Hyderabad, India
Dr. Shrishil Department of Gastroenterology, Asian Institute of Gastroenterology (AIG), 6-3-661, Somajiguda, Hyderabad, India
Dr. Suresh Babu Department of Gastroenterology, Asian Institute of Gastroenterology (AIG), 6-3-661, Somajiguda, Hyderabad, India

Keywords: Exocrine and endocrine deficiencies, fecal elastase, functional outcome, morphological changes, OGTT, steatorrhoea, Whipples Pancreaticoduodenectomy

Abstract

Aim and objective: To compare the effect of pancreatic anastomosis(Modified (duct to mucosa) Buchler and Binding PJ(Pengs)) on long term exocrine, endocrine function and morphological changes in remnant pancreas after pancreaticoduodenectomy. Secondarily the Correlation of exocrine and endocrine function to morphological changes based on MRI triphasic+ MRCP(pancreatic protocol) was studied.

Results: In the Randomized control study group with 1 year follow up, 10 out of 13 in the binding group and 13 out of 14 in the buchler group had <200 micro g/g of stool.7out of 13 in binding group and 10 out of 14 in the buchler group had deranged glucose tolerance tests. There was no statistical difference.

In the retrospective group with even longer follow up with 3 to 5 year follow up, 10 out of 12 in the binding group and 9 out of 12 in the buchler group had <200 micro g/g of stool. 7 out of 12 in binding group and 8 out of 12 in the buchler group had deranged glucose tolerance tests. There was no statistical difference. In both RCT and retrospective group, there were no difference between the groups based on MRI characteristics which implied similar pancreatic morphological changes occurred in both groups. Similarly there was no correlation between the morphological and the functional changes.

Conclusion: Both the Buchler and Binding Pancreaticojejunostomy had a similar effect on the exocrine, endocrine function and morphological changes after pancreaticoduodenectomy. There was no correlation between the morphological and functional changes after pancreaticoduodenectomy.