Effect of Reconstruction-Method after Radical Subtotal Gastrectomy on Gall Bladder Motility: A Prospective Study, Short Term Follow-up

ABSTRACT

BACKGROUND: Several clinical observations suggest that the incidence of gallbladder stone increases after gastric surgery. The mechanism is not clear, but many investigators have proposed that the cause may be decreased gallbladder motility due to vagal denervation. However, the authors observed a increased-incidence of gallbladder stone in Billroth II anastomosis (gastrojejunostomy) and an unchanged- incidence of that in Billroth I anastomosis (gastroduodenostomy) after a radical subtotal gastrectomy. METHODS: We studied the change in the motility of gallbladder after gastrectomy, prospectively. Gallbladder ejection fraction was compared pre- and postoperatively by gallbaldder scintigraphy with DISIDA. RESULTS: 32 patients were involved in this study. They were all thought to have early gastric cancer, preoperatively and received a radical subtotal gastrectomy. 20 patients underwent a Billroth I anastomosis and 12 patients, Billroth II anastomosis after gastrectomy. The mean ejection fractions of the Billroth I group were 75.9% and 46.4%, pre- and postoperatively, and those of the Billroth II group were 78.2% and 45.3%. There were no difference of ejection fractions between the two groups. However a significant difference existed between the preoperative and the postoperative ejection fractions in each group. CONCLUSIONS: These findings may mean that the gastrectomy (it means vagal denervation) may be the major cause of the decreased gallbladder motility and that the reconstruction method after a gastrectomy may have no significant effect on gallbladder motility.