[Increased bile acid retention in biliodigestive Roux-Y anastomosis in animal experiment].
In an experimental study on 65 rats the influence of different Roux-Y biliary anastomoses on the enterohepatic bile acid circulation was investigated. Long (10 cm) and short (3 cm) isoperistaltic and long (10 cm) anisoperistaltic Roux-Y loops were studied and compared to sham-operated controls. 75-SeHCAT a y-labeled synthetic bile acid was used for assessment of enterohepatic circulation. Hepatic excretion and enteric bile flow was investigated by 99m-Tc-HIDA. Intestinal transit time was evaluated by 51-Cr-EDTA an inert marker of intestinal contents. Animals with biliary anastomoses showed an increased retention of the synthetic bile acid 75-SeHCAT compared to the controls. Highest retention values were found in animals with anisoperistaltic loops (t1/2 = 98.6 h). Isoperistaltic loops showed uniform values independently of the length of the Roux-limb (t1/2 = 59.8 h resp. 59.3 h). Differences to the controls (t1/2 = 42.6 h) were highly significant (p less than 0.001). In the 99m-Tc-HIDA hepatic excretion into the connected small bowel was normal in all groups. But in rats with biliary anastomoses a marked stasis of the 99m-Tc-HIDA in the Roux-Y loop was apparent. Bowel transit time tested by 51-Cr-EDTA showed comparable results in all groups without significant differences. The results demonstrate an increased bile acid retention in Roux-Y biliary anastomoses. An alteration of the enterohepatic circulation due to stasis in the Roux-Y limb seems to be the underlying mechanism.
Arlt
G
G
Chirurgische Klinik, Medizinische Fakultät der RWTH Aachen.
Bolder
U
U
Bares
R
R
Schumpelick
V
V
D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D000818:Animals; D001647:Bile Acids and Salts / Q000502:physiology*; D002768:Choledochostomy / Q000379:methods*; D002860:Chromium Radioisotopes; D004492:Edetic Acid; D004764:Enterohepatic Circulation / Q000502:physiology; D007098:Imino Acids; D008297:Male; D015609:Organotechnetium Compounds; D010528:Peristalsis / Q000502:physiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D051381:Rats; D013656:Taurocholic Acid / Q000031:analogs & derivatives; D019780:Technetium Tc 99m Lidofenin
D001647:Bile Acids and Salts; D002860:Chromium Radioisotopes; D007098:Imino Acids; D015609:Organotechnetium Compounds; D013656:Taurocholic Acid; D019780:Technetium Tc 99m Lidofenin; C033638:23-seleno-25-homotaurocholic acid; D004492:Edetic Acid
Erhöhte Gallensäurenretention bei biliodigestiven Roux-Y-Anastomosen im Tierexperiment.