This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Oesophageal and gastric bile exposure after gastroduodenal surgery with Henley’s interposition or a Roux‐en‐Y loop. BJS 2004; 91: 580-585.
Published: 13th April 2004
Authors: J.‐Y. Mabrut, J.‐M. Collard, R. Romagnoli, C. Gutschow, M. Salizzoni
Background
The degree which the various reconstruction techniques prevent bile reflux after gastroduodenal surgery has been poorly studied.
Method
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‐$fontss=cmss10 scaled 1000 hbox{ss Y}$ loop after total (22 patients) or subtotal (nine) gastrectomy. Group 3 contained 21 patients with a 60‐cm Roux‐en‐$fontss=cmss10 scaled 1000 hbox{ss Y}$ 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‐$fontss=cmss10 scaled 1000 hbox{ss Y}$ loop. Bilitec® data correlated well with the severity of reflux symptoms and the presence of mucosal lesions. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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