The use of jejunal interposition for intractable symptoms complicating peptic ulcer surgery

Ten patients severely disabled by post-gastrectomy syndromes were allocated to two treatment groups. Those with predominant dumping received a 10-cm antiperistaltic jejunal interposition; those with predominant bile vomiting received a 20-cm isoperistaltic interposition. After follow-up for a minimum of 3 years, 6 patients remained virtually asymptomatic (Visick grades 1 and 2). There were 2 deaths from myocardial infarction, 6 months and 2 years after remedial surgery. One patient developed a stomal ulcer after successful treatment of dumping. Jejunal interposition appears to be a safe and relatively successful procedure. A short antiperistaltic loop is recommended for early dumping; for bile vomiting a longer isoperistaltic segment is a satisfactory alternative to Roux-en-Y conversion.