Duodenogastric bile reflux before and after selective proximal vagotomy with and without pyloroplasty

Duodenogastric bile reflux was determined by nasogastric aspiration in 60 patients with prepyloric, pyloric, or duodenal ulcer before and after selective proximal vagotomy (SPV) or SPV and pyloroplasty (PP). All patients underwent two aspiration tests before and 3 months, 1 year, and 3 years after operation. The highest 1-h output of bile acids was recorded, and 100 mumol x h-1 or more was considered a positive reflux test. Sixteen patients (27%) had positive tests before operation; seven of them had previously been cholecystectomized. Forty-four patients (73%) had negative tests preoperatively; one had been cholecystectomized. Of 43 non-reflux patients without previous cholecystectomy 21 were randomized to SPV and 22 to SPV + PP. Sixteen patients (76%) remained negative after SPV, and 19 of 22 (86%) after SPV + PP. The incidence of negative bile reflux before and after SPV or SPV + PP did not differ. Cholecystectomized patients had a high incidence of bile reflux before (seven of eight) and after (six of eight) SPV or SPV + PP. It is concluded that neither SPV nor PP causes bile reflux.