Hepatobiliary imaging after pancreaticoduodenectomy--a comparative study on Billroth I and Billroth II reconstruction

This study was conducted to compare the passage of bile through the remnant alimentary tract following pancreaticoduodenectomy in patients undergoing Billroth I (Imanaga) and Billroth II (Child) reconstructions, using biliary scintigraphy.

Seven normal human volunteers and 18 patients underwent Child's operation (n=10), or Imanaga's operation (n=8) using hepatobiliary scintigraphy.

In patients who underwent Child's operation (n=10), hepatobiliary scintigraphy showed a prominent stasis of bile tracer in the proximal jejunal loop and a significant time delay occurred at the upper jejunum. The time taken before visualization of 99mTc at the upper jejunum in the patient who underwent Child (65 +/- 5 min) was significantly longer than that in the healthy controls. On the other hand, in the patients who underwent Imanaga's operation (n=8) no bile stasis in the proximal jejunal loop was found and the time taken before visualization of 99mTc of the upper jejunum was similar to that of healthy controls (n=7). Continuous stasis of bile in the proximal loop in patients who undergo Child's operation can therefore cause reflux cholangitis and absorptive disturbances postoperatively in the long term.

The results of this study suggest that Imanaga's reconstruction is a more physiological procedure than Child's reconstruction following pancreaticoduodenectomy.