title: Quality of life and impact of bile reflux after retro colic retro gastric gastrojejunostomy in Whipple surgery.
abstract: BACKGROUND
  Delayed gastric emptying and bile reflux are common concerns in long-term survivors after Whipple surgery. The study was designed to assess modified retro colic retro gastric gastrojejunostomy in reducing macro and microscopic bile reflux and impact on dyspepsia related quality of life in long-term survivors.
  
  
  METHODS
  Out of 43 patients operated, 23 long-term survivors were included. All underwent gastroscopy and bile reflux was grouped as normal, yellowish bile lakes and presence of greenish bile lakes. Six standard gastric biopsies were taken. Microscopic bile reflux index (BRI) was calculated and a score more than 14 was considered significant. Validated Nepean dyspepsia index-short form (NDI-SF) was used to assess the severity of dyspepsia-related quality of life and compared with age and gender-matched control.
  
  
  RESULTS
  The median age was 48 (21-70) years. Median survival of the group was 37 months (6-40). Endoscopically, 20/23 (87%) had macroscopic bile reflux (74% yellowish bile lakes, 13% greenish bile lakes). None had stomal ulcers or macroscopic inflammation. Mean bile reflux index score was 9.7 (range 1.77-34). Mean NDI-SF score of Whipple group was 23.1 (SD 8.88). In controls, mean score was 19.9 (SD 8.23), showing no significant difference (p = 0.245).
  
  
  CONCLUSIONS
  Though there was macroscopic bile reflux, clinical symptoms and microscopic changes were minimal. The modified technique had good long-term results.
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. rohansiriwardana@yahoo.com.
authors.forename: Rohan Chaminda
authors.initials: RC
authors.lastname: Siriwardana
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
authors.forename: Rajapaksha Walimuni Mudiyanselage Anuradha
authors.initials: RW
authors.lastname: Lokubandara
authors.affiliation: Department of Pathology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
authors.forename: Shivanthi Janaki
authors.initials: SJ
authors.lastname: De Silva Hewavisenthi
authors.affiliation: Department of Pathology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
authors.forename: Saumya Kumuduni
authors.initials: SK
authors.lastname: Liyanage
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
authors.forename: Dona Subani Priyangika
authors.initials: DS
authors.lastname: Jayatunge
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
authors.forename: Chandika Anuradha Habarakada
authors.initials: CA
authors.lastname: Liyanage
mesh_terms: D000328:Adult; D000368:Aged; D001655:Bile Reflux / Q000517:prevention & control*; D004415:Dyspepsia / Q000517:prevention & control*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011788:Quality of Life; D055815:Young Adult
keywords: Bile reflux; Quality of life; Whipple surgery