Management of peptic ulcer and enterogastric reflux following conventional gastrojejunostomy and "UNCUT" roux gastrojejunostomy

ABSTRACT

"Uncut" Row gastrojejunostomy had been described for management of postgastrectomy alkaline reflux gastritis and delayed gastric emptying, bus not as primary treatment of chronic duodenal ulcer. This work aims at assessment of enterogastric reflux after truncal vagotomy and uncut Roux gastrojejunostomy in management of chronic duodenal ulcer. Out of 29 patients with chronic duodenal ulcer. 12 were managed by truncal vagotomy [TV] and uncut Roux gastrojejunostomy [UCRGJ], while 17 patients were managed by truncal vagotomy and conventional gastrojejunostomy [GJ]. Enterogastric reflux [EGR] was assessed in both subgroups, before and after surgery, using milk-HIDA scan, and the results were compared to 20 matching healthy controls. EGR showed insignificant increase follows TV+UCRGJ, while it was significantly higher after TV+GJ 3-9 months after surgery, As well the mean EGR was significantly higher in patients with TV+GJ compared to those with TV UCRGJ and controls [16.3 +/- 9.58% Vs 2.6 +/- 3.5% and 1.4 +/- 2.53%] [F=39.931, p=0.000]. Also, patients with TV +UCRGJ had a significantly lower incidence of abnormal EGR compared to those with TV+GJ [16.7% Vs 88.2%] [X[2]=14.854, p=0.00012]. "Uncut" Row gostrojejunostomy is a physiological procedure to be performed as a primary management of chronic duodenal ulcer, as it is not associated with increased enterogastric reflux