The surgical factors influencing duodenogastric reflux

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Abstract
The surgical factors influencing duodenogastric reflux have been assessed in dog and man using the biliary radiopharmaceutical 99mTc‐EHIDA. Cholecystectomy led to a significant increase in the amount of reflux (P<0.01), but the combination of truncal vagotomy and pyloroplasty in addition to cholecystectomy produced a greater amount of reflux (P<0.01). In man, cholecystectomy also resulted in a significant increase in the amount of reflux (P<0.01). In ten control subjects reflux occurred but the amount was small and was not significantly different from the modified highly selective vagotomy group (n = 20). Symptomatic patients after truncal vagotomy and pyloroplasty (n = 16) showed a significant increase in the amount of reflux (P<0.002) but the combination of vagotomy and pyloroplasty in addition to cholecystectomy (n = 15) demonstrated the greatest amount of reflux (P<0.002). Similarly the addition of cholecystectomy to highly selective vagotomy (n = 9) showed a significant increase in the amount of reflux (P<0.02). Reconstruction of the pylorus (n = 8) was not a satisfactory procedure for the prevention of reflux but antrectomy and Roux‐en‐Y biliary diversion (n = 8) resulted in a significant reduction in the amount of reflux (P<0.001) and this was associated with clinical improvement.