GALLBLADDER EMPTYING AFTER ANTIULCER GASTRIC-SURGERY

It has been shown that truncal vagotomy with pyloroplasty (TVP), but n ot highly selective vagotomy (HSV), delays the onset, decreases the ex tent, and changes the pattern of gallbladder emptying. The aim of the present study was to investigate any alterations in gallbladder emptyi ng after a variety of antiulcer gastric surgery, by milk-technetium 99 m (Tc-99m)-dimethyl iminodiacetic acid (HIDA) scintigraphy. After excl uding the cases with spontaneous gallbladder evacuation before milk in gestion, there were 26 controls, 41 duodenal ulcer (DU) patients, 22 a fter HSV (15 prospective cases), 50 after TVP (23 prospective cases), 8 after TV with gastrojejunostomy (TV-GJ), 10 after Billroth I gastrec tomy, and 29 after Billroth II gastrectomy. None of the patients with gastrectomy had additional vagotomy. TVP significantly delayed the ons et and decreased the rate of gallbladder emptying as compared with the control, DU, HSV, and Billroth I groups. TVP also changed the pattern of emptying in 20% of the cases (sequential emptying and refilling ev ents). Antiulcer operations excluding the duodenum (TV-GJ and Billroth II) further reduced the rate of gallbladder emptying as compared with (1) control, DU, HSV, and Billroth I groups (P <0.0001) and (2) TVP ( P <0.001). Onset of gallbladder emptying was not affected by Billroth II gastrectomy, but was significantly delayed by TV-GJ (P <0.001). The latter two operations also significantly changed the pattern of gallb ladder emptying and refilling events, in most cases (P <0.01 versus TV P). In conclusion, all antiulcer procedures, except HSV, greatly distu rb vagally mediated preduodenal mechanism, resulting in delayed onset and reduced rate, whereas duodenal exclusion by gastrojejunostomy resu lts in severely decreased rate of gallbladder emptying.