Abstracts
1997 Digestive Disease Week

Gastrointestinal motility following pylorus-preserving duodenectomy in the dog.

D DeHaan, J Spitz, V Ayasononda, H Richter. Departments of Surgery, Cook County Hospital and Rush University, Chicago, IL.

The location and function of the duodenum endow this intestinal segment with special importance. Our aims were to establish a canine model resembling human anatomy following pylorus-preserving pancreaticoduodenectomy, and to determine the gastrointestinal motor patterns of this model. Materials and Methods Adult beagles underwent resection of duodenum from 1 cm distal to the pylorus. The distal common bile duct was resected, while the pancreatic duct orifice was preserved attached to a button of duodenal wall. The transected jejunum was joined to gallbladder, the pancreatic duct re-implanted into the jejunum 10 cm distally, and the duodenal cuff anastomosed to jejunum another 20 cm aborally. Side-hole manometric catheters were implanted in the gastric fundus, antrum 3 and 6 cm proximal to pylorus, and jejunum 10 cm proximal and 10 and 20 cm distal to the duodenal anastomosis. Control dogs underwent analogous placement of catheters only. Following recovery, dogs underwent at least 3 fasting and 3 fed studies of GI motor activity using a low-compliance pneumohydraulically perfused manometric system linked to pressure transducers and a chart recorder. Recordings were analyzed visually for presence of cyclic and migrating fasting motor patterns, interruption of same by a meal, and occurrence of a "fed" gastric motor pattern. Results Duodenectomy caused weight loss, but dogs otherwise remained well. All 4 controls exhibited classic gastric cyclic activity tightly phase-linked to small bowel MMC's, and all converted to a typical fed pattern. After duodenectomy, all 5 dogs displayed fasting cyclic migrating small bowel activity fronts resembling the control MMC pattern, and all had fasting gastric contractions; in 2 of 5, this was clearly cyclic and phase-linked to small bowel cycles, whereas in 3, no such organization was apparent. After a meal, the small bowel and gastric (when present) fasting cyclic pattern was replaced by a fed-type pattern, including 5/min antral peristalsis. Conclusion Pylorus-Preserving Duodenectomy maintains small bowel MMC-like motility and gastrointestinal fed pattern, but interferes with fasting gastric cyclic activity and gastric-enteric coordination.