Exocrine and endocrine stomach was studied serially in 13 patients who had gastrobulbar preserving pancreatoduodenectomy (GPPD). In most of them, acid output temporarily increased just after operation but recovered. Gastrin response level decreased transiently but returned to the preoperative level. A negative correlation was observed between the acid and gastrin levels, which suggests that the negative feedback mechanism between parietal cells and G cells was maintained. Acid and gastrin levels in GPPD were higher than those in conventional pancreatoduodenectomy (cPD) but not remarkably different from those of the controls. No peptic ulcer was detected after the operation. These findings indicated that GPPD poses little problem concerning offensive factors. Postoperative ulcer formation is considered to be prevented by the authors' procedure, which is devised to best preserve defensive mechanisms so that duodenectomy is minimized and the gastrointestinal continuity is reconstructed physiologically from mouth to anus by end-to-end duodenoduodenestomy, end-to-side pancreatojejunostomy, and end-to-side choledochojejunostomy.
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