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Primary bile reflux gastritis: which treatment is better, Roux-en-Y or biliary diversion?
Am Surg. 2000 May; 66(5):417-23; discussion 423-4.AS

Abstract

Primary bile reflux gastritis is an unusual and elusive problem. Postgastrectomy bile reflux has been long recognized and treated variously with Roux-en-Y gastrojejunostomy, Braun enteroenterostomy, and Henley jejunal interposition. All of these procedures have been fraught with postoperative side effects, the worst of which is stasis. A new procedure utilizing biliary diversion has been proposed to divert bile from the gastric lumen without vagotomy or gastric resection. This procedure was used for 16 patients with diagnosed bile reflux, and results were compared with those of a previous group of 21 patients who had been treated with Roux-en-Y gastrojejunostomy. The patient groups were similar in age, sex, weight, symptoms, and results of investigative studies. The earlier group all had vagotomy, antrectomy, and gastrojejunal anastomosis to a 45-cm Roux limb. The later group all had an end-to-side choledochojejunostomy to a 45-cm Roux limb, taken 45 cm from the ligament of Treitz. The patients in the bile diversion group had fewer complications and shorter hospital stays. In addition, they had few postoperative complaints, no further operations for either bile reflux or upper gastrointestinal stasis, and no long-term deaths due to gastrointestinal problems or malnutrition. Their eventual postoperative gastric emptying improved significantly when compared with the Roux-en-Y patients, suggesting that the dysmotility observed preoperatively may well have been a result of the bile injury to the stomach, rather than an underlying gastric dysmotility.

Authors+Show Affiliations

Department of Surgery, Indiana University Medical Center, Indianapolis 46202-5125, USA.

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Review

Language

eng

PubMed ID

10824740

Citation

Madura, J A.. "Primary Bile Reflux Gastritis: Which Treatment Is Better, Roux-en-Y or Biliary Diversion?" The American Surgeon, vol. 66, no. 5, 2000, pp. 417-23; discussion 423-4.
Madura JA. Primary bile reflux gastritis: which treatment is better, Roux-en-Y or biliary diversion? Am Surg. 2000;66(5):417-23; discussion 423-4.
Madura, J. A. (2000). Primary bile reflux gastritis: which treatment is better, Roux-en-Y or biliary diversion? The American Surgeon, 66(5), 417-23; discussion 423-4.
Madura JA. Primary Bile Reflux Gastritis: Which Treatment Is Better, Roux-en-Y or Biliary Diversion. Am Surg. 2000;66(5):417-23; discussion 423-4. PubMed PMID: 10824740.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary bile reflux gastritis: which treatment is better, Roux-en-Y or biliary diversion? A1 - Madura,J A, PY - 2000/5/29/pubmed PY - 2000/6/10/medline PY - 2000/5/29/entrez SP - 417-23; discussion 423-4 JF - The American surgeon JO - Am Surg VL - 66 IS - 5 N2 - Primary bile reflux gastritis is an unusual and elusive problem. Postgastrectomy bile reflux has been long recognized and treated variously with Roux-en-Y gastrojejunostomy, Braun enteroenterostomy, and Henley jejunal interposition. All of these procedures have been fraught with postoperative side effects, the worst of which is stasis. A new procedure utilizing biliary diversion has been proposed to divert bile from the gastric lumen without vagotomy or gastric resection. This procedure was used for 16 patients with diagnosed bile reflux, and results were compared with those of a previous group of 21 patients who had been treated with Roux-en-Y gastrojejunostomy. The patient groups were similar in age, sex, weight, symptoms, and results of investigative studies. The earlier group all had vagotomy, antrectomy, and gastrojejunal anastomosis to a 45-cm Roux limb. The later group all had an end-to-side choledochojejunostomy to a 45-cm Roux limb, taken 45 cm from the ligament of Treitz. The patients in the bile diversion group had fewer complications and shorter hospital stays. In addition, they had few postoperative complaints, no further operations for either bile reflux or upper gastrointestinal stasis, and no long-term deaths due to gastrointestinal problems or malnutrition. Their eventual postoperative gastric emptying improved significantly when compared with the Roux-en-Y patients, suggesting that the dysmotility observed preoperatively may well have been a result of the bile injury to the stomach, rather than an underlying gastric dysmotility. SN - 0003-1348 UR - https://www.unboundmedicine.com/medline/citation/10824740/Primary_bile_reflux_gastritis:_which_treatment_is_better_Roux_en_Y_or_biliary_diversion DB - PRIME DP - Unbound Medicine ER -