Changes in Biliary Tract Enzymes after Reconstruction by Jejunal Interposition and the Roux-en Y Procedure after Total Gastrectomy

Hiroki Akamatsu, Masaki Kamegashira, Atsushi Ohkawa, Motoo Yoshitatsu

Department of Surgery, Ashiya City Hospital

In recent years jejunal interposition has been used frequently as a more natural reconstructive method after total gastrectomy. Postoperative changes in biliary tract enzymes and results of ultrasound examination after reconstruction by jejunal interposition (group A, n=14) and the Roux-en Y procedure (group B, n=18) were evaluated and compared to determine the effect of the difference in reconstructive methods on the biliary system. The levels of biliary enzymes were significantly higher in group A than in group B one week and one month after surgery. The levels were within the normal range in all patients in group B throughout the observation period. Postoperative ultrasound examination revealed no gallstones in either group, and the common bile duct was not dilated in either group. This postoperative elevation of biliary enzyme levels in group A is thought to be related to a loss of coordination between the duodenum, the interposed jejunum, and the distal jejunum after reconstruction by jejunal interposition. Further study is necessary to determine the mechanism and the clinical significance of this phenomenon.

Key words
total gastrectomy, biliary system, gallstone

Reprint requests
Hiroki Akamatsu Department of Surgery, Ashiya City Hospital
39-Asahigaoka-cho, Ashiya, 659 JAPAN

Accepted
May 8, 1991

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