Pancreatic exocrine function after a sutureless pancreaticojejunostomy following pancreaticoduodenectomy

Exocrine pancreatic function was measured in 14 patients after pancreaticoduodenectomy for periampullary neoplasms in order to assess the patency of a sutureless pancreatico‐enteric anastomosis. Pancreatic function was examined by the p‐aminobenzoic acid/p‐aminosalicylic acid (PABA/PAS) test 3–160 months after operation and compared with age‐ and sex‐matched controls. There were no significant differences between mean (s.e.m.) serum PABA concentrations 3 h after ingestion of N‐benzoyl‐L‐tyrosyl‐PABA (25·5 (3·6)) μmol/l for patients, 26·1 (2·0 (μmol/l for controls)). However, the mean (s.e.m.) PABA excretion index was significantly lower in the patients (0·58 (0·08)) than in the controls (0·76 (0·04)). Four patients required pancreatic enzyme supplements for control of diarrhoea. Self‐limiting pancreatic leaks occurred in two patients. The results suggest that the sutureless pancreatico‐enteric anastomosis has an acceptably low leakage rate but that pancreatic exocrine function is diminished following pancreaticoduodenectomy with this technique. However, the majority of patients require no enzyme supplements and no significant tendency to late stenosis of the anastomosis was demonstrated.