Does different approach during pancreatoduodenectomy influence intestinal migrating myoelectrical complex recovery? Study in experimental pig model.

ABSTRACT

It is said that leaving intact the functional motor unit of the pylorus leads to better gastric emptying and reduces postoperative upper gut motility disturbances. However, despite obvious different surgical approach, both major pancreatoduodenectomies lead to substantial myoelectrical dysfunctions. The latter are not efficiently recognized. We compared Whipple and Longmire-Traverso procedures in terms of electromyography patterns of the upper jejunum musculature and the density of Cajal cells network. Twelve male weaned pigs underwent surgery first to implant bipolar electrodes and telemetry transmitters for continuous electromyography recordings and then, after 1 week recovery, to create Whipple (n=6) and Longmire-Traverso (n=6) pancreatoduodenectomies. The first myoelectric activity was already registered 1-2 hours after both operations. Time to first regular patterns of migrating myoelectrical complex activity was significantly longer in the Whipple than in the Longmire-Traverso group (68.2±12.9 versus 27.8±51 hours, p=0.002). However, the restored patterns were substantially disturbed in both groups. Namely, after Longmire-Traverso operation, migrating myoelectrical complex cycles were very often and significantly shorter versus control ones, with reverse migration in the area of anastomosis while after Whipple procedure migrating myoelectrical complex cycles were less frequent and of short duration, significantly shorter in comparison even with Longmire-Traverso group. Cajal cells network in the vicinity of anastomosis, and distally from it, presented greater destruction after the Whipple operation. In conclusion, the advantage of one of two major pancreatoduodenectomies in terms of myoelectrical activity correctness in upper gut has not been proved in the study.