Preventing bile reflux by intussusception gastroduodenostomy

Conventional gastroduodenostomy after partial gastric resection allows duodenogastric reflux in a significant number of patients. Such reflux can be correlated with gastritis and complaints of heartburn, epigastric pain, and, occasionally, bile vomiting. Techniques to prevent reflux after gastroduodenal anastomosis were evaluated in dogs. Telescoping gastroduodenostomy (10 dogs) resulted in stenosis of the telescoped stomach and gastric outlet obstruction. Another technique, intussusception gastroduodenostomy (10 dogs), was evaluated by barium X-ray, endoscopy, gastric analysis, and autopsy studies in selected animals at 2, 6, 12, and 15 months. No dog showed signs of gastric obstruction or antral gastritis. No reflux was demonstrated radiographically. One of three dogs examined 1 year after the operation had bile in one of eight samples of gastric aspirate. Stomachs of sacrificed animals were not enlarged. One showed gastritis histologically at the site of gastric mucosal protrusion into the duodenum. An average of 23.5 cm of water pressure in the duodenum was required to force water to reflux through the anastomosis in resected specimens. Water ran freely from the stomach into the duodenum without generating pressure. In dogs surviving as long as 15 months intussusception gastroduodenostomy proved to be a remarkably effective means of preventing duodenogastric reflux. This technique might be clinically useful to prevent postoperative symptoms related to bile reflux and to treat the syndrome of alkaline reflux gastritis.