Small bowel transit and gastric emptying after biliodigestive anastomosis using the uncut jejunal loop

Evaluation of Hepatobiliary Excretion and Enterobiliary Reflux in Rats with Biliary Obstruction Submitted to Bilioduodenal or Biliojejunal Anastomosis

“…These results differ from those of studies in which rats without previous BO were submitted to standard or uncut BJ anastomosis and evaluated after 28 [11] or 180 days [7]. In those studies, intense hepatic fibrosis with abscesses, focal fatty degeneration, hepatocyte necrosis, and ductal proliferation were detected, especially after standard BJ anastomosis.…”

“…Nevertheless, it has been reported that rats with BO submitted to BJ anastomosis with a 2.5-cm Y loop present no enterobiliary reflux [23]. Similarly, enterobiliary reflux was not observed when standard BJ anastomosis was compared with BJ anastomosis without transection of the jejunal loop [11]. Enterobiliary reflux and the presence of motor dysfunction in the excluded Roux-en-Y loop, together with stasis in the bile duct, favor bacterial proliferation and explain the delay in hepatobiliary excretion observed in our study, as well as the higher incidence of cholangitis detected in humans [1,2,22].…”

“…These motor disorders of the excluded loop favor bile stasis and cholangitis. Among the proposed alternatives are uncut BJ anastomosis, which preserves the continuity of the intestinal wall and separates the enteric content of the bile duct by occlusion of the jejunal lumen [7,11], and BJ anastomosis with duodenojejunal anastomoses [2,22], which has the objective of decompressing the excluded loop with stasis.…”

“…Dynamic hepatic scintigraphy evaluates hepatocellular function and bile duct permeability by means of radiotracers that are taken up by the hepatocytes, secreted through the bile duct, and finally excreted into the small intestine. Gastrointestinal transit and enterobiliary reflux can be studied by means of removing the organs and taking static readings of the radiation emitted by the organs and their contents [11,16,17].…”

“…In clinical practice, selection of the modality of biliary anastomosis used in cases of extrahepatic BO depends more on the experience of the surgeon than on the pathogenesis of the disease to be treated [3]. BD and BJ anastomoses are frequently employed in extrahepatic BO; however, even when the anastomoses are pervious, episodes of cholangitis may occur due to enterobiliary reflux [6] or due to stasis in the Roux-en-Y excluded loop [7,10,11].…”