Anterior gastrojejunostomy versus posterior gastrojejunostomy in mini-gastric bypass: a comparative study in bile reflux

Abstract

Intro duction An alternative to the gold standard Roux-en-Y gastric bypass is the one-anastomosis gastric bypass procedure. Although the safety and effectiveness of this method are widely recognized, there are still many unanswered issues about the prospective long-term dangers owing to biliary reflux and its potential complications. However, problems from the mini-gastric bypass (MGB) surgery have drawn attention, particularly the reflux of jejunal contents, including bile and pancreatic secretions, into the gastric tube or even the esophagus, a condition known as bile reflux in the literature. Aim To determine whether the incidence of bile reflux differs between anterior and posterior gastrojejunostomies. Patients and methods A total of 50 patients without gastroesophageal reflux disease symptoms or a hiatus hernia who were scheduled for MGB surgery at our facility between August 2021 and April 2022 were included in the research. Patients received hepatobiliary scintigraphy 6 months following the procedure. The patients were divided into two groups: group A consisted of 25 patients who underwent anterior antecolic gastrojejunostomy, and group B consisted of 25 patients who underwent posterior retrocolic gastrojejunostomy. Results After being divided into two groups randomly, 50 patients were recruited in the study. The included patients had a mean age of 38.55 years, a mean weight of 125.36 kg, and a mean BMI of 50.1 kg/m2, with 86% of them being females. In 24 (48%) individuals with Bile reflux scintigraphy (BRS), there was no evidence of bile reflux into the stomach or esophageal pouch. In group A with an anterior antecolic gastrojejunostomy, 14 (28%) patients had a positive BRS, whereas in group B with a posterior retrocolic gastrojejunostomy, 12 (24%) patients showed bile reflux activity. Conclusion Our findings show that temporary bile reflux after MGB occurs often in the gastric tube and maybe in the esophagus and that the location of the gastrojejunostomy has no bearing on the presence of bile reflux.