Prevention of ulcer after pancreatic surgery

Extensive pancreatic resections for cancer are complicated by gastrojejunal ulceration and hemorrhage in a significant number of survivors. Experimental evidence indicates that an increase in production of gastric acid accounts for these ulcers, rather than a loss of alkaline pancreatic secretions. Hypersecretion of acid is induced by an operative procedure which preserves the pancreatic islets while preventing adequate enzymes from reaching the upper part of the small bowel. This hypersecretion is sharply reduced by gastric antrectomy. The experiments reported herein show that oral pancreatic enzymes can lower or prevent hyperacidity if they are begun immediately after operation, before hyperacidity becomes established. Enzymes also seem more effective after pyloroplasty or antrectomy. These observations support the essential role of pancreatic enzymatic digestion in regulating gastric acidity. In patients undergoing pancreatoduodenectomy, three steps seem important: (1) removal of the gastric antrum, (2) anastomosis of the pancreatic tail to the jejunum, and (3) administration of oral enzymes in the early postoperative period. Clinical experience with thirty-one patients is described, in which two hospital deaths ( 6 1 2 per cent) and no anastomotic ulcers occurred.