Bile reflux after laparoscopic mini/one anastomosis gastric bypass: the problem and prevention

Abstract

Currently, laparoscopic mini-gastric bypass (LMGB) is a common bariatric surgical operation. One of the reasons for reoperations after LMGB is pathological bile reflux, which, in addition to a noticeable decrease in the quality of life of patients, poses a potential threat to the neoplastic processes in the stomach and esophagus. This study aimed to systematize and analyze modern literature information on terminology, diagnosis and frequency of detection, pathophysiological significance, and methods of preventing bile reflux post-LMGB. Russian and English full-text studies on bile reflux after LMGB in the bibliographic databases of the Russian Science Citation Index, PubMed, Google Scholar, and ScienceDirect were analyzed. The frequency of diagnosing bile reflux after LMGB varies from 2.0 to 57.9%, depending on the instrumental diagnostic methods used: flexible endoscopy, 24-hour pH impedance measurements, spectrophotometry of bilirubin in refluxate, and hepatobiliary scintigraphy. The pathogenetic effect of the contents of the small intestine on the mucous membrane of the stomach and esophagus after LMGB is noted because of the direct cytotoxic and receptor-mediated effects of bile acids. The safety of the main stages of LMGB (creation of a gastric pouch and formation of a single anastomosis) is currently being reviewed from the standpoint of minimizing the risk of developing bile reflux. Furthermore, novel techniques have been proposed to reduce the likelihood of intestinal contents entering the stomach and esophagus; however, their effectiveness remains controversial.