RNY causes Bile Reflux also...

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Hi,

Just a note that shows that Bile reflux occurs after RNY surgery also...

Roux-en-Y jejunal loop and bile reflux.

" CONCLUSIONS: Bile refluxes over the whole length of 4 Roux-en-Y loops out

of 10. "

Am J Surg 2000 Apr;179(4):298-303

Collard JM, Romagnoli R

Department of Surgery, Louvain Medical School, Brussels, Belgium.

BACKGROUND: The current opinion is that the reflux of jejunal juice over the

whole length of a long Roux-en-Y jejunal loop is very uncommon. We aimed to

challenge this concept by monitoring the presence of bile in the organ

proximal to a 60-cm loop during a 24-hour period with use of the Bilitec

device, an optoelectronic instrument capable of measuring absorbance of a

beam of light, the wavelength of which is close to the absorbance peak of

bilirubin.

PATIENTS AND METHODS: Forty-one patients, 8 of whom had been

cholecystectomized, were investigated after total gastrectomy (group I, n =

17), distal gastrectomy (group II, n = 7), or duodenal switch (group III, n

= 17). The percentage of recording time absorbance >0. 25 (absorbance scale

ranging from 0 to 1) was calculated in reference to data from healthy

subjects.

RESULTS: Bile was detected in 17 patients (41%), 5 belonging to group I, 2

to group II, and 10 to group III (P = 0.165). Bile exposure remained within

the range of controls in 14 patients whereas it was above this range in 3

patients, 2 of whom had disabling heartburn and severe esophagitis. The

percentage of time absorbance >0.25 did not significantly differ from one

group to another (P = 0.257) or according to whether patients had been

cholecystectomized or not (P = 0.439). However, unlike cholecystectomized

patients, patients still having their gallbladder refluxed predominantly

during postprandial periods. Lengthening of the loop from 60 cm to 110 cm in

the 2 symptomatic patients with a pathologic bile reflux resulted in relief

of heartburn and healing of esophagitis in both while bile reflux was

abolished in 1 and dramatically reduced in the other.

CONCLUSIONS: Bile refluxes over the whole length of 4 Roux-en-Y loops out of

10. In most patients, bile reflux remains within the range of healthy

subjects, producing neither symptoms nor mucosal damage; and it occurs

independently of the organ proximal to the loop, but its timing of

occurrence is modified by cholecystectomy. Although only for exceptional

indications, lengthening of an incompetent loop is effective in patients

with excessive bile reflux and severe related symptoms and lesions.

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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Re: Oct. 12 littermates- especially Teri's

husband

> Are you as nervous as I am? We just get to sit and wait. Sorry we won't

be

> in the same waiting room but I'll be including your wife in my prayers so

> please put in a few words for my daughter in yours. (Just to cover all

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> bases, I have prayers going

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>

> Is the 12th here yet?

>

> 's Mother. . .

>

>