Re: Its Not the Bile that Causes Problems...

[Guest guest]

Thanks, Dr R-

That 'mini-bile lecture' was very informative.

Regina in Charlotte

[Guest guest]

Ouch!

More RNY problems....

Surg Today 1999;29(6):553-6 Related Articles, Books, LinkOut

Laparoscopic surgery for blind pouch syndrome following Roux-en Y

gastrojejunostomy: report of a case.

Takiguchi S, Yano H, Sekimoto M, Taniguchi E, Monden T, Ohashi S, Monden M

Department of Surgery, Osaka Teishin Hospital, Japan.

We report herein the case of a 59-year-old man in whom blind pouch syndrome

was successfully treated by laparoscopic surgery. The patient had undergone

distal gastrectomy and Roux-en Y gastrojejunostomy for a peptic ulcer 35

years previously, and had been suffering from watery diarrhea, anemia,

weight loss, and pain in the left upper quadrant of his abdomen for several

years. Long-term insufficient oral intake and the malabsorption of nutrients

had resulted in severe emaciation. Gastrointestinal contrast study revealed

a large blind pouch, 30 x 23cm in diameter, draining into the

gastrojejunostomy. Laparoscopic resection of the blind pouch was performed.

Despite the presence of dense intraabdominal adhesions, we identified the

blind pouch with the help of tattoo marks that had been made at the neck of

the pouch preoperatively. After thoroughly dissecting the adhesions around

the pouch, we resected the pouch at the neck. The patient had an uneventful

postoperative course. This case report demonstrates that large blind pouches

such as this may be effectively treated using laparoscopic surgery.

RR

Rutledge, M.D., F.A.C.S.

The Center for Laparoscopic Obesity Surgery

4301 Ben lin Blvd.

Durham, N.C. 27704

Telephone #:

Fax #:

Email: DrR@...

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Its Not the Bile that Causes Problems...

> Hi,

>

> Its not the bile that cause the problems its the Acid!

> According to this study: Reflux symptoms are much more often related to

> ACID reflux than Bile reflux. Bile reflux does not seem to be a major

factor

> in producing esophageal symptoms.

>

> The relationship between acid and bile reflux and symptoms in

> gastro-esophageal reflux disease.

> Gut 1997 Feb;40(2):182-7

>

> Marshall RE, Anggiansah A, Owen WA, Owen WJ

>

> Department of Surgery, Guy's Hospital, London.

>

> BACKGROUND: The role of bile in the genesis of esophageal symptoms and

> disease is incompletely understood. A new method of ambulatory bile

> monitoring may help to define this role. AIMS: To establish the

relationship

> between symptom events and acid and bile reflux episodes.

>

> PATIENTS: 59 consecutive patients presenting for further investigation of

> gastro-esophageal reflux disease.

>

> METHODS: All patients underwent combined ambulatory pH and bile

monitoring.

> For each patient, a symptom index (SI) was calculated in relation to both

> acid reflux and bile reflux episodes.

>

> RESULTS: Patients were divided into those without (group 1, n = 21) and

> those with (group 2, n = 38) acid reflux. A total of 394 symptoms were

> identified in 59 patients. In group 1, there were fewer symptom events per

> patient (mean 4.1) than group 2 (mean 8.1). Twenty three per cent of

symptom

> events were associated with acid reflux in group 1 and 41% in group 2.

Only

> 6% of symptom events in both groups were related to bile reflux. In group

1

> both the acid and bile related SI score were low. In group 2 the bile

> related SI score was low, but the acid related SI score was high.

>

> CONCLUSIONS: Symptoms are much more often related to acid reflux than bile

> reflux. Bile reflux does not seem to be a major factor in producing

> esophageal symptoms.

>

> RR

>

> Rutledge, M.D., F.A.C.S.

> The Center for Laparoscopic Obesity Surgery

> 4301 Ben lin Blvd.

> Durham, N.C. 27704

> Telephone #:

> Fax #:

> Email: DrR@...

>

>

>