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Tierexperimentelle Untersuchungen zur Genese von Anastomosenulzera nach refluxbelasteter und refluxverhütender Magenresektion

Experimental evaluation in anastomotic ulcer risk after partial gastrectomy with and without duodeno-gastric reflux

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Summary

In an animal experiment the role of bile reflux in development of anastomotic ulcer after partial gastrectomy was investigated. On 45 pigs 2/3 partial gastrectomies and on 5 animals only laparotomies were carried out. The ulcer risk after reconstruction procedures with possible bile reflux was compared with reflux-free techniques. Anastomotic ulcer developed after maximal exposure of the gastric remnant to bile as well as after reflux-free reconstructions: B-II-Roux, 40 cm jejunum loop (n=5/10); B-II-Roux, 20 cm jejunum loop (n=3/5); B-II-Roux, 40 cm jejunum loop and truncal vagotomy (n=1/5); B-I and choledochojejunostomy (n=2/10); BII-Roux, 40 cm jejunum loop and Choecystogastrostomy (n=4/5). After B-I resection with medium duodeno-gastric reflux (n=0/10) and in the control group (n=015, laparotomy only) no ulcer occurred. Because basal acid output after B-I and B-II-Roux resection was reduced to O mval/h, stimulated gastric acid seems to be important in development of anastomotic ulcer. The experimental results prove the protective role of postresectional duodenogastric reflux. After partial gastrectomy for primary ulcer surgery reconstruction procedures guaranteeing duodenogastric reflux should be preferred to Roux-en-Y gastrojejunostomy.

Zusammenfassung

Die Bedeutung des Gallerefluxes nach Magenresektion für die Entstehung von Anastomosenulzera wurde tierexperimentell untersucht. Hierzu erfolgten bei 45 Hausschweinen 2/3-Magenresektionen und bei 5 Tieren eine Probelaparotomie. Refluxverhütende und refluxbelastete Formen der Passagerekonstruktion Roux, 40-cm-Schlinge (n=5/10); B-II-Roux, 20-cm-Schlinge (n=3/5); B-II-Roux, 40-cm-Schlinge mit trunkulärer Vagotomie (n=1/5); B-I mit Choledochojejunostomie (n=2/10) and B-II-Roux, 40-cm-Schlinge mit Cholezystogastrostomie (n=4/5). Nach B-I-Resektion mit Gewährleistung eines mittleren duodenogastralen Refluxes (n=0110) and in der Kontrollgruppe (Probelaparotomie,n=0/5) traten keine Ulzera auf. Als Ursache der Anastomosenulzera nach refluxverhütender Rekonstruktion muß, da experimentell die basale Säuresekretion nach B-I- wie B-II-Roux-Magenresektion ausgeschaltet werden konnte, zephalisch, gastral oder intestinal stimulierte, nicht durch duodenales Refluat gepufferte Säure diskutiert werden. Die erhobenen tierexperimentellen Befunde belegen den ulkusprotektiven Charakter des postresektionellen duodenalen Refluates. Sie sprechen gegen die klinische Anwendung der refluxverhütenden Gastrojejunostomie nach Roux als primäre Rekonstruktion nach Magenresektion wegen gastroduodenaler Ulzera und für Verfahren, die einen duodenogastralen Reflux gewährleisten.

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Authors and Affiliations

  1. Klinik für Allgemein- und Abdominalchirurgie, der Johannes Gutenberg-Universität, Langenbeckstraße 1, W-6500, Mainz, Bundesrepublik Deutschland

    S. Walgenbach,  Th. Junginger, S. Wölfinger & J. Schollmeyer

  2. Pathologisch-Anatomisches Institut, der Johannes Gutenberg-Universität, Langenbeckstraße 1, W-6500, Mainz, Bundesrepublik Deutschland

    C. Hage

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  1. S. Walgenbach
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  2. Th. Junginger
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  3. C. Hage
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  4. S. Wölfinger
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  5. J. Schollmeyer
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Walgenbach, S., Junginger, T., Hage, C. et al. Tierexperimentelle Untersuchungen zur Genese von Anastomosenulzera nach refluxbelasteter und refluxverhütender Magenresektion. Langenbecks Arch Chiv 376, 69–76 (1991). https://doi.org/10.1007/BF01263463

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  • DOI: https://doi.org/10.1007/BF01263463

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