An Experimental Study on Development of Gallstone Disease after Gastrectomy-Postoperative Alteration of the Composition of Canaine Gallbladder Bile after Partial Gastrectomy-

Yuzuru Sugiyama, Ryukichi Hada*, Hiroshi Moriya*, Hiroyasu Kobori*, Dai Seito*, Yasunori Mikami*, Hidetoshi Suzuki*, Mitsuru Konn*

Hirosaki University School of Allied Medical Sciences
*Second Department of Surgery, Hirosaki University School of Medicine

In connection with reported higher incidences of gallstone disease (GS) after gastrectomy, we had examined changes in the composition of gallbladder (GB) bile collected through external cholecystostomy from subtotal-gastrectomized dogs with truncal vagotomy. Black stones containing calcium bilirubinate developed in 3/7 gastrectomized dogs but not in 4 external-cholecystostomied control dogs. Analysis of bile suggested that altered bile composition possibly related to bile infection may be a lithogenic factor and that gastrectomy may promote the process of lithogenesis. The high possibility of bile infection through cholecystostomy, however, urged further investigations utilizing canine models without cholecystostomy. Bile was obtained from 5 pylorus-preserving gastrecotmized (PPG), 6 Billroth-II gastrectomized and truncal-vagotomized (B-II) and 6 control (sham operation) dogs by GB puncture during laparotomy at gastric surgery, 6 and 12 postoperative months. Five PPG and 6 control dogs incurred neither bile infection nor GS. Though free bile acids were detected in GB bile from 2/5 PPG dogs, there were no other remarkable changes in bile acids composition in these groups. B-II dogs incurred bile infection in 3/6 (two at 6 months, one at 6 and12 months) and GS in3/6. Bile culture was positive for 2/3 dogs with GS. A more marked alteration in bile acids composition was found in B-II dogs compared with those in other two groups. B-II may be more liable to bile infection and subsequent derangement of bile composition with a resultant high incidence of GS.

Key words
gallstone disease after gastrectomy, subtotal gastrectomy (BII) with truncal vagotomy, pylorus-preserving gastrectomy, bile infection, bile acids

Reprint requests
Yuzuru Sugiyama Hirosaki University School of Allied Medical Sciences
66-1 Honn-cho, Hirosaki, 036 JAPAN

Accepted
February 8, 1995

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