The ulcer risk in reflux preventive gastric operations. An experimental study

The ulcer risk of duodenogastric antireflux operations following gastric resection was analyzed experimentally in 162 rats. After gastric resection a Roux-Y gastrojejunostomy or jejunal transposition of various length were done. 10 month postoperatively a follow-up was performed consisting of endoscopy, analysis of gastrin and gastric secretion, gastric emptying tests and histamine stimulation. A high incidence of stomal ulceration was found, which was directly related to the length of the interposed jejunal segment. The reflux free stomachs within 10 month developed stomal ulcerations in 72.7%, after additional 2 mg/kg histamine stimulation in 100%. The aetiology of these ulcers seems to be acid related, because all reflux-free stomachs showed a very low pH. Reflux preventive operations are demonstrated to be a modification of the Mann-Williamson experiment. They should be used carefully or avoided.