Abstracts
1997 Digestive Disease Week

The effect of the anastomotic size on gastric emptying after hemigastrectomy with Billroth II reconstruction.

SH Tyndall, MA Memon, R Lund, D Beck, J Fessenden, RJ Fitzgibbons Jr. Creighton University School of Medicine, Omaha, NE.

To determine if the size of the gastrojejunal anastomosis after Billroth II reconstruction and not the diameter of the small bowel is the rate limiting factor in gastric emptying in the postoperative period.

Twelve mongrel dogs were used for this study. Each dog had three solid and three liquid radiolabeled emptying studies prior to Billroth II hemigastrectomy. All twelve dogs were randomized either to have 1.5 cm anastomoses (the diameter of the normal jejunum) or 5 cm gastrojejunal anastomoses prior to undergoing Billroth II hemigastrectomy. Following six weeks of postoperative recovery, each dog underwent six gastric emptying studies using radioisotope labeled meals, three for solids and three for liquids. Data was collected using a gamma camera interfaced to a computer which recorded images for forty seconds. For liquid studies, images were obtained at 0,2,4,6,8, and 10 minutes, and then every 10 minutes for a total of 60 minutes. For solid studies, images were obtained at 0, 5 and 10 minutes, and then 10 minutes for a total of 120 minutes. Regression analysis was used to compare the slope of the gastric emptying curves for liquids and solids.

Post-operative liquid emptying was significantly faster in the first ten minutes with both 1.5 cm anastomoses (p=.0002) and 5 cm anastomoses (p=.0007) compared to pre-operative scans in the same animals. When the post-operative liquid gastric emptying of 1.5 cm anastomoses was compared to 5cm anastomoses there was no significant difference. Solid gastric emptying on the other hand was much slower post-operatively with the 1.5 cm anastomosis compared to preoperative scans (29% vs 65% p=.0001). There was no difference in solid gastric emptying with 5 cm anastomoses in pre- and post-operative scans (62% and 59%, p=ns). When the post-operative solid gastric emptying of 1.5 cm anastomoses was compared to 5 cm anatomoses, the delay was statistically significant with the smaller anatomoses (29% vs 62%, p=0.0001).

Our model suggests that the gastric emptying of solids is affected by the size of the gastrojejunal anastomosis following Billroth II reconstruction. Contrary to popular opinion, we conclude that the size of the lumen of the small bowel is not the limiting factor for solid emptying in the post-operative period following gastrointestinal anastomosis.