A new biliodigestive anastomosis technique to prevent reflux and stasis.
BACKGROUND
The Roux-en-Y procedure for biliodigestive drainage is most widely accepted, but 10% to 15% of patients postoperatively suffer from a blind-loop syndrome or cholangitis due to motility disorders. A new biliodigestive technique is evaluated in a rat model to prevent these complications.


METHODS
This experimental study in Wistar rats compares the Roux-en-Y technique with a new biliodigestive anastomosis creating a jejunal loop with luminal occlusion. Clinical parameters, small bowel motility, bacteriologic growth, and liver histopathology were evaluated in native and postoperative animals within a study period of 180 days.


RESULTS
Both operative procedures were well tolerated. After 6 months intense fibrosis of the liver and high-grade purulent cholangitis were observed in animals in the Roux-en-Y group. In these animals enterobacter and enterococci overgrowth was found. Myoelectric small bowel recordings revealed significant impairment of slow-wave frequency, aboral velocity, and action potentials (percentage of phase III) in Roux-en-Y animals.


CONCLUSIONS
Motility disorders after conventional Roux-en-Y biliodigestive anastomosis are pivotal for histomorphological damage and infectious findings and can be prevented by using the new technique to create a jejunal loop with luminal occlusion.
Klaus
A
A
Department of General and Transplant Surgery, Innsbruck University Hospital, Anichstrasse 35, A-6020, Innsbruck, Austria.
Weiss
H
H
Kreczy
A
A
Eigentler
A
A
Neher
C
C
Margreiter
R
R
Pernthaler
H
H
D000713:Anastomosis, Roux-en-Y; D000818:Animals; D018988:Bacterial Translocation; D002761:Cholangitis / Q000517:prevention & control*; D002767:Cholecystostomy / Q000379:methods*; D004576:Electromyography; D005769:Gastrointestinal Motility; D007582:Jejunostomy / Q000379:methods*; D007583:Jejunum / Q000473:pathology; D008103:Liver Cirrhosis / Q000473:pathology; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D051381:Rats; D017208:Rats, Wistar; D018709:Statistics, Nonparametric