Abstracts
1997 Digestive Disease Week

Gastrointestinal transit and stress response after laparoscopic versus conventional distal pancreatectomy in dogs.

T Naitoh, A Garcia-Ruiz, A Darvish, A Vladisavljevic, S Matsuno, M Gagner. First Department of Surgery, Tohoku University School of Medicine, Sendai, Japan, Minimally Invasive Surgery Center and Center for Anesthesiology Research, The Cleveland Clinic Foundation, OH.

A variable degree of postoperative ileus and surgical stress occurs after conventional distal pancreatectomy (CDP). We hypothesized that laparoscopic distal pancreatectomy (LDP) should result in less surgical stress and a faster recovery of postoperative ileus than CDP. Ten mongrel dogs were randomly operated for CDP or LDP. Four trocars were used to perform the LDP, while a 20-cm midline incision was used for the CDP. Fed state gastrointestinal transit times were radiographically assessed using radiopaque markers, and we measured the first bowel movement (BM), gastric emptying time (GET), and mouth to anus transit time (MAT). To assess surgical stress, we determined IL-1, IL-6, TNF-alpha like substances, cortisol, amylase and glucose serum levels at 4h, 8h, 1d, 3d, and 7d after surgery. Baseline transit studies and blood samples were taken in all dogs before surgery. The next table summarizes our transit studies:

          Baseline             Postop
         GET       MAT         GET         MAT        BM
 LDP   3.9±1.3   19.8±4.9   19.5±2.9*   31.3±6.4   18.1±3.9
 CDP   2.5±0.6   14.6±4.7   26.5±3.3*   39.3±4.3*  33.1±3.5**
 * p<0.05 vs. Baseline, ** p<0.05 vs. LDP mean±SEM (hour)

No significant differences between groups were seen in postoperative GET and MAT. However, postoperative MAT in LDP was not prolonged while GET in both groups and MAT in CDP were significantly prolonged compared with baseline study. Besides, first bowel movements were observed significantly earlier in LDP than in CDP. Serum cortisol levels elevated significantly at 4 hours after skin incision in both groups (LDP; 12.2±1.4, CDP; 14.3±2.1µg/dl) (p<0.05), and decreased thereafter. In LDP, they returned close to the normal level at 8 hours after incision (5.4±0.9µg/dl), but still significantly higher in CDP (8.9±1.9µg/dl). Serum amylase and glucose did not elevate after surgery in both groups. The level of IL-1 like substances were elevated in both groups at 8 hours (LDP; 0.284±0.026, CDP 0.421±0.097) and 24 hours (LDP; 0.329±0.075, CDP; 0.588±0.077) after incision. Besides, the level of IL-1 like substances were significantly higher in CDP than in LDP at 24 hours after incision (p<0.05). IL-6 and TNF-alpha like substances did not represent significant elevation. Thus, we conclude that laparoscopic distal pancreatectomy demonstrated faster recovery of the bowel transit and less stress than conventional distal pancreatectomy in dogs.