The results of reoperation for bile vomiting following surgery for peptic ulcer

Abstract

A retrospective study is presented of 91 patients (72 male and 19 female) who underwent remedial surgery in the Gastro–intestinal Unit, Western General Hospital, between 1958 and 1972 for bile vomiting following surgery for peptic ulcer. The mean follow–up period was 5.2 years. Fifty‐eight (63.8 per cent) patients had undergone a previous gastric resection, 26 (28.5 per cent)a vagotomy and drainage operation and 7 (77 per cent)a gastrojejunostomy alone. At reoperation no abnormality could be found to account for the vomiting in 29 (30.9 per cent)patients, 52 (57.1 per cent) had an obstructed afferent loop, efferent loop or stoma and 6 (6.6 per cent) had acute gastritis only. Twelve (13.2 per cent)patients had a recurrent ulcer. Preoperative barium meal examination and gastroscopy together correcrly indicated the operative findings in 846 per cent of cases. For bile vomiting following Polya gastrectomy 64–68 per cent of those who had a Roux‐en‐ Y conversion or an isoperistaltic jejunal interposition obtained lasting relief of symptoms, as against 55 per cent of patients who had their Polya anastomosis converted to a Billroth Z type. Where the original operation had been a vagotomy and drainage procedure 71 per cent of those converted to a Polya gastrectomy did well, but conversion to a different type of drainage or refashioning of the existing anastomosis was successful in only 40 per cent. The results in 28 patients with a concomitant psychoneurosis were not significantly different from those in the rest of the group.

Reconstruction of the pylorus

“…Roux-en-Y diversion is the most commonly performed procedure for bile reflux and vomiting. From 14 reports [7,13,[21][22][23][24][25][26][27][28][29][30][31][32] we estimate that the average satisfactory response rate with Roux diversions is 71% (200 of 282 cases). Moreover, mortality or significant morbidity is recorded in 6 of those 14 studies.…”

“…Since in most reports on surgical treatment of "post-gastrectomy sequelae" the primary operation was gastrectomy, comparison of results with pyloroplasty reconstruction is difficult. Furthermore, only occasionally is the fact obvious that sequelae are frequently multiple [8,21] and attention is usually not focused on these minor problems, so that the overall result in terms of Visick grading is difficult to judge. Roux-en-Y diversion is the most commonly performed procedure for bile reflux and vomiting.…”

Long-Term Results of the Cut-Closed-Reconnected Roux Loop for Enterogastric Reflux

“…The afferent limb will be cut at the level of the stomach and closed at the gastric side, while the other lumen is connected with the rest of the small bowel. Because of the difficulty in technique, the chance of persistent bile reflux and ulcerations in the jejunal interposition, this operation has gone out of use for a long time [14]. From an anatomical point of view with the jejunal interposition according to Henley, the small bowel segment has been moved to another location in order to achieve duodenal transit.…”

B II-Y-Roux-Anastomose ? Resektionsverfahren der Wahl bei der komplizierten Ulcuskrankheit?

“…Im Gegensatz zu amerikanischen Autoren [5,8,9], die generell die Vagotomie bei der Wiederherstellung nach B II-Roux fordern, vagotomieren Bfinte und Langhans nicht, ohne hierunter gehfiuft Ulcera gesehen zu haben [1].…”

“…Ihre technische Einfachheit hat zu ihrer Verbreitung bei der Gastrektomie beigetragen. Die Anwendung der Roux-Anastomose bei Nachresektion wegen Anastomosenulcus oder massivem Gallenreflux ffihrte in einem hohen Prozentsatz zu Ulcusrezidiven; Griffith, Kennedy und Herrington [5,8,9] fordern daher fibereinstimmend die zus/itzliche Vagotomie.…”