Gastric acidity after pancreatoduodenectomy: influence of surgical
technique and peri-operative medical treatment.
M.J.M. Morak1, T.C.K. Tran1, M.J. Bruno2, W.C.J. Hop3, G. Kazemier1, J. de Jonge1 and
C.H.J. van Eijck1
1
Department of Surgery
Erasmus Medical Center, Rotterdam, The Netherlands
2
Department of Gastroenterology and Hepatology
Erasmus Medical Center, Rotterdam, The Netherlands
3
Department of Biostatistics
Erasmus MC, Rotterdam, The Netherlands
Background: Gastric acid at the anastomotic site after pancreaticoduodenectomy might cause
peptic ulcers. This study was performed to compare gastric acidity after pylorus-preserving
pancreatoduodenectomy (PPPD) and classical Whipple’s resection, in addition we assessed
the effect of proton pump inhibitors (PPIs) and somatostatin analogues.
Method: In a prospective cohort study, 50 (69%) patients underwent a PPPD and 22 a
classical Whipple’s resection. Patient received intramuscular Sandostatin long acting release
(LAR) (n=48; 67%) or subcutaneous octreotide (n=23; 32%). Esomeprazole was started
following operation if not used pre-operatively. Gastrin levels were measured before and on
day 2 after surgery together with gastric acidity.
Results: Multivariate analysis showed that the type of somatostatin analogue and preoperative PPI were independent determinants of gastric acidity two days postoperatively. The
type of resection or post-operatively started PPIs had no effect on gastric acidity. There was a
positive relation between serum gastrin levels and gastric pH. The type of resection, type of
somatostatin analogue or PPIs had no influence on serum gastrin.
Conclusion: There is no difference between PPPD or classical Whipple’s resection on postoperative gastric acidity. Pre-operative use of PPIs and the administration of subcutaneous
octreotide resulted in diminished gastric acidity on day 2 postoperatively, which may prevent
anastomotic ulcers. Sandostatin LAR resulted in significantly higher gastric acidity.