Oesophageal and gastric bile exposure after gastroduodenal surgery with Henley's interposition or a Roux-en-Y loop

Background: The degree which the various reconstruction techniques prevent bile reflux after gastroduodenal surgery has been poorly studied. Methods: Bile exposure in the intestinal tract just proximal to the jejunal loop was measured with the Bilitec 2000® device for 24 h after gastroduodenal surgery in three groups of patients. Group 1 comprised 24 patients with a 60‐cm Henley's loop after total gastrectomy. Group 2 included 31 patients with a 60‐cm Roux‐en‐$\font\ss=cmss10 scaled 1000 \hbox{\ss Y}$ loop after total (22 patients) or subtotal (nine) gastrectomy. Group 3 contained 21 patients with a 60‐cm Roux‐en‐$\font\ss=cmss10 scaled 1000 \hbox{\ss Y}$ loop anastomosed to the proximal duodenum as part of a duodenal switch operation for pathological transpyloric duodenogastric reflux. Bile exposure, measured as the percentage time with bile absorbance greater than 0·25, was classified as nil, within the range of a control population of healthy subjects, or pathological (above the 95th percentile for the control population). Reflux symptoms were scored and all patients had upper gastrointestinal endoscopy. Results: Bile was detected in the intestine proximal to the loop in none of 24 patients in group 1, eight of 31 in group 2 and 12 of 21 in group 3 (P < 0·001). The mean reflux symptom score increased with the degree of bile exposure, and the proportion of patients with oesophagitis or gastritis correlated well with the extent of bile exposure (P < 0·001). Conclusion: A long Henley's loop was more effective in preventing bile reflux than a long Roux‐en‐$\font\ss=cmss10 scaled 1000 \hbox{\ss Y}$ loop. Bilitec® data correlated well with the severity of reflux symptoms and the presence of mucosal lesions. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Jejunal interposition prevents bile reflux