Oesophageal and gastric bile exposure after gastroduodenal surgery with Henley's interposition or a Roux-en-Y loop
(2004) British Journal of Surgery — Vol. 91, n° 5, p. 580-585 (2004)
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- 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(R) 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(R) data correlated well with the severity of reflux symptoms and the presence of mucosal lesions.
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Mabrut, J., Collard, J.-M., Romagnoli, R., Gutschow, C., & Salizzoni, M. (2004). Oesophageal and gastric bile exposure after gastroduodenal surgery with Henley’s interposition or a Roux-en-Y loop. British Journal of Surgery, 91(5), 580-585. https://doi.org/10.1002/bjs.4569 (Original work published 2004)