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Duodenogastrischer Reflux nach Vagotomie und Pyloroplastik

Duodenogastric reflux after vagotomy and pyloroplasty

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Summary

In 27 patients after selective or truncal vagotomy and pyloroplasty the occurrence of duodenogastric reflux was checked by two methods, by the measurement of Bromsulphalein (BSP)-concentration in the gastric aspirate after BSP was given intravenously and by instillation of a barium meal in the second part of the duodenum followed by upper GI-series. In 20 of 23 patients reflux was recorded radiologically, in 18 of 27 patients reflux was shown by the BSP-Method.

Proven bile reflux was associated with major postoperative discomfort, such as epigastric fullness, nausea and epigastric pain, it was also associated with gastritis as shown by microscopic examination of biopsies taken from the antrum.

It is recommended to consider duodenogastric reflux as a possible reason for patients complaints after vagotomy and pyloroplasty. To avoid those complaints the preference of proximal gastric vagotomy without pyloroplasty is supported, if preoperative gastric emptying is not impaired.

Zusammenfassung

Bei 27 Patienten mit selektiver oder trunkulärer Vagotomie und Pyloroplastik wurde geprüft, ob ein duodenogastrischer Reflux vorliegt. Die Untersuchung erfolgte röntgenologisch durch Instillation von verdünntem Bariumbrei in das Duodenum und durch Nachweis von i.v. appliziertem Bromsulphalein im Magensaft. Es konnte bei 20 von 23 Patienten röntgenologisch und bei 18 von 27 Patienten durch den Bromsulphalein-Nachweis ein duodenogastrischer Reflux festgestellt werden. In Zusammenhang mit Reflux standen postoperative Beschwerden wie Völlegefühl, Brechreiz und Oberbauchschmerzen, sowie der Nachweis morphologischer Veränderungen der Magenschleimhaut im Sinne von Gastritiden verschiedener Stadien.

Es wird empfohlen, bei Beschwerden nach Vagotomie und Pyloroplastik auch an einen duodenogastrischen Reflux als ögliche Ursache zu denken. Zur Vermeidung solcher Beschwerden wird bei präoperativ normaler Magenentleerung die proximal gastrale Vagotomie ohne Pyloroplastik empfohlen.

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Authors and Affiliations

  1. Chirurgische Universitätsklinik, Langenbeckstraße 1, D-6500, Mainz 1, Bundesrepublic Deutschland

    M. Rothmund & G. Deisler

  2. Institut für Klinische Strahlenkunde der Universität, Langenbeckstraße 1, D-6500, Mainz 1, Bundesrepublic Deutschland

    A. Kaufmann

  3. Pathologisches Institut der Universität, xLangenbeckstraße 1, D-6500, Mainz 1, Bundesrepublik Deutschland

    P. Höhn

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  1. M. Rothmund
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  2. G. Deisler
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  3. A. Kaufmann
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  4. P. Höhn
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Rothmund, M., Deisler, G., Kaufmann, A. et al. Duodenogastrischer Reflux nach Vagotomie und Pyloroplastik. Langenbecks Arch Chiv 340, 167–178 (1976). https://doi.org/10.1007/BF01254854

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  • DOI: https://doi.org/10.1007/BF01254854

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