Roux-en-Y gastroenterostomy severely disturbs emptying of the gallbladder

It is documented that truncal vagotomy and Billroth II gastroenterostomy disturbs the emptying of the gallbladder. The aim of the present prospective study was to assess the emptying of the gallbladder after Roux-en-Y gastroenterostomy.

There were 34 patients, who had undergone either truncal vagotomy with pyloroplasty (TVP, 14 instances) or Billroth II gastrectomy (20 instances), and were subsequently subjected to Roux-en-Y gastroenterostomy. The emptying of the gallbladder was assessed before and after the Roux-en-Y procedure, by milk-technetium-99m labeled hepatoiminodiacetic acid (milk-99mTc-HIDA) scintigraphy. Milk-99mTc-HIDA scintigraphy was also performed on twenty-eight healthy subjects, who served as the control group.

After excluding the subjects having spontaneous gallbladder evacuation before milk ingestion, there remained 26 subjects in the control group, 12 patients with TVP, and 19 with Billroth II gastrectomy. Truncal vagotomy with pyloroplasty was associated with delayed onset (p < 0.001) and decreased rate (p < 0.01) of emptying of the gallbladder compared with the control group. Truncal vagotomy with pyloroplasty also changed the normal pattern of emptying in two patients (sequential emptying and refilling events). Billroth II gastrectomy was associated with decreased extent and abnormal pattern of emptying compared with subjects in the control group (p < 0.0001) and patients having TVP. Roux-en-Y gastroenterostomy, performed upon patients with TVP, significantly increased lag phase duration (p < 0.001), decreased ejection fraction (p < 0.01), and changed the pattern of emptying of the gallbladder (p < 0.01). Roux-en-Y procedure performed upon patients with Billroth II gastrectomy significantly increased lag phase duration (p < 0.0001).

Roux-en-Y gastroenterostomy severely disturbs all parameters of the emptying of the gallbladder.