ROUX-EN-Y GASTROENTEROSTOMY SEVERELY DISTURBS EMPTYING OF THE GALLBLADDER

BACKGROUND: It is documented that truncal vagotomy and Billroth II gas troenterostomy disturbs the emptying of the gallbladder. The aim of th e present prospective study was to assess the emptying of the gallblad der after Roux-en-Y gastroenterostomy. STUDY DESIGN: There were 34 pat ients, who had undergone either truncal vagotomy with pyloroplasty (TV P, 14 instances) or Billroth II gastrectomy (20 instances), and were s ubsequently subjected to Roux-en-Y gastroenterostomy. The emptying of the gallbladder was assessed before and after the Roux-en-Y procedure, by milk-technetium-99m labeled hepatoiminodiacetic acid (milk-Tc-99m- HIDA) scintigraphy. Milk-Tc-99m-HIDA scintigraphy was also performed o n twenty-eight healthy subjects, who served as the control group. RESU LTS: After excluding the subjects having spontaneous gallbladder evacu ation before milk ingestion, there remained 26 subjects in the control group, 12 patients with TVP, and 19 with Billroth II gastrectomy. Tru ncal vagotomy with pyloroplasty was associated with delayed onset (p<0 .001) and decreased rate (p<0.01) of emptying of the gallbladder compa red with the control group. Truncal vagotomy with pyloroplasty also ch anged the normal pattern of emptying in two patients (sequential empty ing and refilling events). Billroth II gastrectomy was associated with decreased extent and abnormal pattern of emptying compared with subje cts in the control group (p<0.0001) and patients having TVP. Roux-en-Y gastroenterostomy, performed upon patients with TVP, significantly in creased lag phase duration (p<0.001), decreased ejection fraction (p<0 .01), and changed the pattern of emptying of the gallbladder (p<0.01). Roux-en-Y procedure performed upon patients with Billroth II gastrect omy significantly increased lag phase duration (p<0.0001). CONCLUSIONS : Roux-en-Y gastroenterostomy severely disturbs all parameters of the emptying of the gallbladder.