[Duodenogastric reflux and anastomosis abscess. Experimental study]

Different types of duodenal by-pass operations with and without duodenogastric reflux were performed on 54 male Wistar rats. The results of our investigation show that following duodenal by-pass with reflux peptic anastomotic ulcer regularly occurs. The constant reflux of bile and pancreas juice is the most important aetiologic factor in the development of ulcer in the vicinity of the anastomosis between the stomach and small intestine. Stasis in the by-passed duodenum (afferent loop syndrome) promotes ulcerogenic action of reflux. In the absence of the pylorus the effects of reflux and stasis potentiate, resulting in a high frequency of ulcer (greater than 90%). With intact pylorus the incidence is low. Duodenogastric reflux prevents hydrochloric acid secretion significantly (p less than o,o1); hydrochloric acid thus plays a minor role in the development of experimental anastomotic ulcer of the rat. -- In considering the prophylaxis against anastomotic ulcer, these findings support the claim of avoiding surgical techniques involving duodenal by-pass and reflux (Billroth II with short loop GE). Gastric resection should, therefore, aim at the reconstruction of the orthograde peristalsis.