THE EFFECT OF SURGICAL TECHNIQUE ON DUODENOGASTRIC REFLUX AFTER CHOLECYSTECTOMY

Abstract

Objective: It is stated in the literature that some patients have dyspeptic complaints after months from cholecystectomy. The reason for this situation has not been established. It is more often attributed to the bile leakage from the duodenum to the stomach. Therefore, in our study we investigated whether the surgical technique applied during cholecystectomy caused postoperative duodenogastric reflux. In this study, it was aimed to investigate the effects of Calot's triangle dissection type (high dissection, low dissection) on post-operative duodenogastric reflux due to Oddi’s sphincter dysfunction during laparoscopic cholecystectomy.Material and Methods: In the study, laparoscopic cholecystectomy was performed in two groups. One day before cholecystectomy, all patients underwent gastroscopy. During cholecystectomy, dissection of gallbladder was carried out close to the gallbladder in the first group (high dissection), while dissection was carried out close to ductus choledochus in the second group (low dissection). Two months after the operation, all patients were called back and gastroscopy was performed. Whether there was bile reflux from pylorus to the stomach was checked.Results: Of the patients, 78.3% were female and 21.7% were male. The average age was 51.5 years (min-max: 25-76 years). Most of the patients (n:19, 31.7%) were in the 4th decade. Post-operative bile reflux was detected in 25 (41.7%) of all patients. Duodenogastric reflux was detected in 6 patients in group 1 and 19 patients in group 2. While there was a statistically significant relationship between the occurrence of postoperative reflux and dissection type, age, ASA score and presence of diabetes, no relationship was found with gender.Conclusion: If less duodenogastric reflux is desired after cholestectomy, we recommend dissection rather close to the gallbladder during cholecystectomy.