Gallbladder emptying after antiulcer gastric surgery

Area of Science:

• Gastroenterology
• Surgical Oncology
• Hepatobiliary Surgery

Background:

• Gallbladder emptying is a complex physiological process influenced by various factors.
• Previous studies indicated that truncal vagotomy with pyloroplasty (TVP) affects gallbladder emptying, unlike highly selective vagotomy (HSV).

Purpose of the Study:

• To investigate the impact of different antiulcer gastric surgeries on gallbladder emptying patterns.
• To compare the effects of various surgical procedures on the onset, rate, and pattern of gallbladder emptying.

Main Methods:

• Milk-technetium 99m (99mTc)-dimethyl iminodiacetic acid (HIDA) scintigraphy was used to assess gallbladder emptying.
• Patients were categorized into control, duodenal ulcer (DU), post-HSV, post-TVP, post-TV with gastrojejunostomy (TV-GJ), post-Billroth I, and post-Billroth II gastrectomy groups.

Main Results:

• TVP significantly delayed onset and decreased the rate of gallbladder emptying compared to controls and other groups.
• Operations excluding the duodenum (TV-GJ, Billroth II) further reduced emptying rates and altered emptying patterns, showing sequential emptying and refilling events.
• HSV did not significantly affect gallbladder emptying, while TVP and duodenal exclusion surgeries markedly disturbed its pattern, onset, and rate.

Conclusions:

• Most antiulcer surgical procedures, excluding HSV, significantly impair gallbladder emptying dynamics.
• Truncal vagotomy may disrupt vagal mechanisms, leading to delayed onset and reduced rates.
• Duodenal exclusion surgeries severely decrease gallbladder emptying rates and alter emptying patterns.