Determination of the optimal reconstruction for pancreaticoduodenal resection based on modified scintigraphy of gastrointestinal motility

Abstract

Aim. To improve the outcomes of pancreaticoduodenal resection by determining the optimal reconstruction based on objective assessment of the functional state of the upper gastrointestinal tract using a modified “double” scintigraphic study.Materials and methods. 147 pancreaticoduodenal resections were performed in the period of 2016–2022. Patients underwent “double” scintigraphic study on days 30 and 90 after surgery. The mean age of the patients was 59.6 years (23–83); the male to female ratio was 1.27:1. All patients underwent gastropancreatoduodenal resection or pancreatoduodenal resection with pylorus preservation. The patients were divided into 3 groups according to the variant of the reconstructive stage of surgery. Group 1 underwent reconstruction according to Child, group 2 – Child reconstruction and interintestinal anastomosis formation according to Brown, the reconstructive stage in group 3 involved Roux-en-Y isolation of the small intestine (Roux-en-Y reconstruction).Results. “Double” scintigraphic study revealed that the best result on the 30th and 90th postoperative days was observed in patients who underwent pancreaticoduodenal resection with pylorus preservation, reconstructive stage according to Child and formation of interintestinal anastomosis after Brown.Conclusion. “Double” scintigraphy is an effective procedure to determine the motility of the stomach, biliodigestive anastomosis and motility of the small intestine. As a result, the optimal reconstruction after pancreaticoduodenal resection was determined in patients with neoplasms of the pancreatic head or the periampullary region and chronic pancreatitis.