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Oesophageal and gastric bile exposure after gastroduodenal surgery with Henley's interposition or a Roux-en-Y loop.

AbstractBACKGROUND:
The degree which the various reconstruction techniques prevent bile reflux after gastroduodenal surgery has been poorly studied.
METHODS:
Bile exposure in the intestinal tract just proximal to the jejunal loop was measured with the Bilitec 2000 device for 24 h after gastroduodenal surgery in three groups of patients. Group 1 comprised 24 patients with a 60-cm Henley's loop after total gastrectomy. Group 2 included 31 patients with a 60-cm Roux-en-Y loop after total (22 patients) or subtotal (nine) gastrectomy. Group 3 contained 21 patients with a 60-cm Roux-en-Y loop anastomosed to the proximal duodenum as part of a duodenal switch operation for pathological transpyloric duodenogastric reflux. Bile exposure, measured as the percentage time with bile absorbance greater than 0.25, was classified as nil, within the range of a control population of healthy subjects, or pathological (above the 95th percentile for the control population). Reflux symptoms were scored and all patients had upper gastrointestinal endoscopy.
RESULTS:
Bile was detected in the intestine proximal to the loop in none of 24 patients in group 1, eight of 31 in group 2 and 12 of 21 in group 3 (P < 0.001). The mean reflux symptom score increased with the degree of bile exposure, and the proportion of patients with oesophagitis or gastritis correlated well with the extent of bile exposure (P < 0.001).
CONCLUSION:
A long Henley's loop was more effective in preventing bile reflux than a long Roux-en-Y loop. Bilitec data correlated well with the severity of reflux symptoms and the presence of mucosal lesions.
AuthorsJ-Y Mabrut, J-M Collard, R Romagnoli, C Gutschow, M Salizzoni
JournalThe British journal of surgery (Br J Surg) Vol. 91 Issue 5 Pg. 580-5 (May 2004) ISSN: 0007-1323 [Print] England
PMID15122609 (Publication Type: Journal Article)
CopyrightCopyright 2004 British Journal of Surgery Society Ltd.
Topics
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomosis, Roux-en-Y (methods)
  • Bile (physiology)
  • Bile Reflux (etiology, prevention & control)
  • Duodenal Diseases (surgery)
  • Female
  • Gastrectomy (methods)
  • Humans
  • Jejunum (surgery)
  • Male
  • Middle Aged
  • Postoperative Complications (etiology, prevention & control)
  • Stomach Diseases (surgery)

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