Open AccessExperimental and Clinical Results with Proximal End-to-End Duodenojejunostomy for Pathologic Duodenogastric Reflux
Author(s) -
Tom R. DeMeester,
Karl Hermann Fuchs,
Chris S. Ball,
Mario Albertucci,
T. C. Smyrk,
Joseph Marcus
Publication year - 1987
Publication title -
annals of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.153
H-Index - 309
eISSN - 1528-1140
pISSN - 0003-4932
DOI - 10.1097/00000658-198710000-00003
Subject(s) - medicine , duodenum , reflux , gastroenterology , vagotomy , stomach , roux en y anastomosis , gastric emptying , bile reflux , gastric acid , surgery , disease , gastric bypass , weight loss , obesity
Existing Roux-en-Y bile diversion procedures for duodenogastric reflux coupled with distal gastric resection or antrectomy and vagotomy have varied success due to interruption of the physiologic relationships between stomach and duodenum, the reduction of the gastric reservoir, the side effects of vagotomy, and the effect of the Roux limb on gastric emptying. A new bile diversion procedure, suprapapillary Roux-en-Y duodenojejunostomy, was studied, which eliminates the need for gastric resection to prevent jejunal ulcers by preserving duodenal inhibition of gastric acid secretion and the protective effects of duodenal secretion on the surrounding mucosa. Experimentally, the incidence of jejunal ulceration was significantly decreased by the preservation of the proximal duodenum. Clinically, bile diversion by suprapapillary Roux-en-Y duodenojejunostomy alleviates symptoms of duodenogastric reflux disease without being ulcerogenic (in the presence of normal gastric secretion) or prolonging gastric emptying.