Gallbladder Motility after Duodenum-Preserving Resection of the Head of the Pancreas

Abstract

Background: Duodenum-preserving resection of the head of the pancreas (DPRHP) is performed in patients with chronic painful pancreatitis (CP) localized in the head of the pancreas. It has been suggested that functional integrity of the upper digestive tract is preserved after DPRHP. We tested this hypothesis with regard to gallbladder motility. Methods: Gallbladder motility and cholecystokinin (CCK) secretion were studied fasting, after cephalic vagal stimulation with sham feeding, and after regular feeding in 9 patients after DPRHP, in 6 unoperated patients with CP, and 9 healthy control subjects. Results: Mean fasting gallbladder volume in patients after DPRHP (49 ± 10 cm³) and patients with CP (53 ± 10 cm³) was larger than in controls (33 ± 3 cm³). Sham-feeding-stimulated gallbladder contraction did not differ between patients after DPRHP, patients with CP, and controls. Both postprandial CCK secretion and gallbladder contraction in patients after DPRHP (78 ± 16 pM 120 min; 47% ± 6%) and patients with CP (72 ± 18pM 120 min; 40% ± 7%) were significantly reduced (P < 0.05) compared with controls (151 ± 13 pM 120 min; 74% ±4%). Fasting gallbladder volume, sham feeding, and regular-feeding-induced gallbladder contraction and postprandial CCK secretion did not differ between operated and unoperated patients with CP. Conclusions: Gallbladder motility and CCK secretion are reduced in patients with pancreatic insufficiency. A DPRHP procedure does not further influence these results. These findings support the concept that gallbladder motor function is preserved after DPRHP.

Key Words:

• Cholecystokinin
• chronic pancreatitis
• gallbladder motility
• duodenum-preserving pancreatic head resection
• pancreatic insufficiency
• sham feeding