It is reported that patients with pylorus-preserving pancreatoduodenectomy (PpPD) could get better nutritional conditions than standard pancreatoduodenectomy (PD), after recovery from gastric stagnation following PpPD. In order to estimate postoperative functions of each procedure, we investigated serial changes of gastrointestinal motility and nutritional parameters of patients after PD (n=10) vs. PpPD easurement of gastic emptying and intestinal transit. Delayed gastric emptying and accelerated intestinal transit one month after PpPD were normalized at 6 months or later, while accelerated gastric emptying and intestinal transit of PD patients continued for a long period. Body weights and serum cholesterol levels of PpPD patients were recovered better than those of PD at 6 months or later. Although there were no differences in gastrointestinal motility and nutritional parameters between Billroth I type (gastro-pancreato-biliary) and Billroth II type (pancreato-biliary-gastric) reconstruction following PpPD, postoperative gastric stagnation occured more often in Billroth I type. Thus, we take advantage in PpPD over PD and in Billroth II type over Billroth I type reconstruction following PpPD.

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Motility of the reconstructed intestine and the secretion profile of gut hormones (gastrin and motilin) were experimentally examined in dogs receiving total gastrectomy with Rouxen Y reconstruction in the postprandial and fasting periods. The following results were obtained.
(1) After total gastrectomy, motor activities of the reconstructed intestine increased immediately after feeding. A new interdigestive migrating contractions (IMC) appeared in the fasting periods in the ascending portion of the reconstructed jejunum. Abnormal migrations of IMC were frequently seen early after operation.
(2) In the interdigestive pattern of the blind-loop duodenum, a reduction in phase I and III and, a prolongation in phase II and in the cycle of phase III appearance were observed compared with the control dog.
(3) Motilin secretion has not decreased after feeding and, in the fasting periods, increased to coincide with IMC of the blind-loop duodenum. The newly appearing IMC of the ascending jejunum, however, were not accompanied by an increase in motilin secretion. In contrast, gastrin secretion was low with little fluctuation both in the postprandial and fasting periods.
Based on these findings, it is considered that the motor disorders of the reconstructed intestine, the blind-loop duodenum and changes in gut hormone secretion are, at least partially, the causes of postoperative complaints after total gastrectomy.

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Using adult mongrel dogs, we experimentally investigated the gallbladder emptying after total gastrectomy from the relation ship between the endogenous cholecystokinin (CCK) secretion kinetics and the blind-loop duodenal motility.
Postprandial gallbladder emptying was about 60% by 60 minutes in the totally gastrectomized dogs, the same as in the control dogs, then the volume increased. Serum CCK secretion in the totally gastrectomized dogs rapidly increased until 50 minutes after the meal in accordance with the gallbladder emptying compared with the control dogs. On the other hand, during fasting the gallbladder underwent partial refilling synchronous with phase I in the blind-loop duodenum and emptying throuth phase II into the latter half of phase II, but the volume of the gallbladder was greater than that in the control dogs. Moreover, the cycle of gallbladder partial emptying and refilling was prolonged with prolongation of the phase III appearance cycle. Variation of serum CCK secretion during fasting was not observed.
From the above redults, it is suggested that the abnormality of gallbladder emptying after total gastrectomy mainly depends on the change in the endogenous CCK secretion kinetics in the digestive state and, on the other hand, in the interdigestive state it is correlated with the change in the blind-loop duodenal motility pattern.

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