Abstract | BACKGROUND: 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.
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Authors | J-Y Mabrut, J-M Collard, R Romagnoli, C Gutschow, M Salizzoni |
Journal | The British journal of surgery
(Br J Surg)
Vol. 91
Issue 5
Pg. 580-5
(May 2004)
ISSN: 0007-1323 [Print] England |
PMID | 15122609
(Publication Type: Journal Article)
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Copyright | Copyright 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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