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Bile diversion after total gastrectomy

I A Donovan, J W Fielding, H Bradby

    The British Journal of Surgery
    |July 1, 1982
    PubMed
    Summary
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    This study investigated bile reflux after gastrectomy using 99Tcm-HIDA scans. Longer Roux-en-Y reconstructions effectively prevented esophageal bile reflux and associated symptoms.

    Area of Science:

    • Gastroenterology
    • Nuclear Medicine
    • Surgical Oncology

    Background:

    • Total gastrectomy often leads to bile reflux into the esophagus.
    • This can cause significant patient discomfort and esophagitis.
    • Effective surgical reconstruction is crucial for managing post-gastrectomy complications.

    Purpose of the Study:

    • To evaluate a method for studying esophageal bile reflux after total gastrectomy using 99Tcm-HIDA.
    • To compare the efficacy of omega and Roux-en-Y reconstructions in preventing bile reflux.
    • To correlate reflux findings with esophagitis and symptoms.

    Main Methods:

    • Utilized 99Tcm-HIDA scintigraphy and an external imaging system to assess bile reflux.
    • Studied two surgical reconstruction types: omega (with entero-anastomosis) and Roux-en-Y.

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  • Analyzed the correlation between reflux incidence, esophagitis, and symptom severity.

    • Main Results:

    • Esophageal bile reflux detected by scanning correlated strongly with esophagitis and severe symptoms.
    • The omega reconstruction was ineffective in bile diversion in 5 patients.
    • Roux-en-Y reconstruction with a diverting limb <35 cm failed in 5 patients; those with limbs >35 cm showed no reflux.

    Conclusions:

    • 99Tcm-HIDA scintigraphy is a viable method for studying post-gastrectomy bile reflux.
    • Roux-en-Y reconstruction with a sufficiently long diverting limb (40-50 cm) effectively prevents esophageal bile reflux.
    • Surgical technique and limb length are critical factors in preventing bile reflux complications.