[Ulcer risk of reflux-preventing reconstruction following stomach resection--an animal experiment study]

In an experimental study on 376 rats the ulcer risk was analyzed after Roux-Y-gastrojejunostomy resp. jejunal interposition. The following results were obtained: 5 to 10 months postoperatively stomal ulcers were found in up to 90%. The longer the jejunal segment, i.e. the lesser the reflux, the higher was the ulcer risk. The interval of ulcer manifestation could be shortened to 7 resp. 10 days by continuous histamine stimulation, while the differences between the groups remained unchanged. An extended resection was of negligible influence on the elevated ulcer risk in long jejunal segments, that means refluxfree conditions. The gastric pH was influenced by the length of the jejunal segment, the longer the segment, the more acid was the pH. With long, refluxfree segments normal pH-values could be observed despite of an extended gastric resection. An additional vagotomy caused a reduction but not an elimination of the ulcer risk. We conclude from our results, that there is a protective role of the postresectional intestino-gastric reflux on the gastrojejunal anastomosis. A refluxpreventive procedure is therefore heavily ulcerprone.