incidence of duodenogastric reflux after cholecystectomy with or without choledochoduodenostomy

ABSTRACT

Persistence of dyspeptic symptoms after cholecystectomy with choledochoduodenostomy is common. There is evidence that at least some of these symptoms may be attributed to duodenogastric reflux. The aim of the study is to evaluate whether more duodenogastric reflux is found after cholecystectomy plus choledochoduodenostomy than after cholecystectomy alone. Twenty four patients after cholecystectomy plus choledochoduodenostomy, twenty one after cholecystectomy and fiveteen control patients were studied to evaluate whether differences existed in the duodenogastric reflux and whether these were related to morphological damage of the gastric mucosa. Duodenogastic reflux measured by 99m TC-hepatic imino diacetic acid scintigraphy. 5 mci Tc-99m Mebrofenin was used for scanning the hepatobiliary system on a Siemens Icon-Gamma camera with predefined computer software. The stomach was localized using Tc-99m sulphur colloid. Reflux activity in the range of 1-14 percent was considered insignificant. The damage was evaluated histologically by systematic endoscopic biopsy of the antrum and body of the stomach. Thirteen patients after cholecystectomy plus choledochoduodenostomy [54.17%] showed a insignificant duodenogastric reflux <14%. In eleven patients [45.83%] duodenogastric reflux was significant. After cholecystectomy, sixteen patients [76,19%] had insignificant duodenogastric, five patients [23.81%] had significant duodenogastric reflux. The quantitative difference in reflux was insignificant [p>0.05]. Only two patients of control group [13.33%] had significant duodenogastric reflux. There was a statistically difference [p<.05] between control group and patients with cholecystectomy plus choledochoduodenostomy. The distribution of chronic antral atrophic and superficial gastritis was different in the three groups [p<0.05]. Chronic atrophic gastritis was associated with cholecystectomy plus choledochoduodenostomy [p<0.01], while chronic superficial gastritis was more frequent in cholecystectomizedpatien patients. These results suggest that there may be more duodenogastric reflux after cholecystectomy plus choledochoduodenostomy than after cholecystectomy alone, and that may be a correlation between the amount of duodenogastric reflux and the severity of mucosal damage