Roux-en-Y versus interposition biliary reconstruction.

We compared two types of biliary reconstruction for congenital dilatation of the bile duct--Roux-en-Y hepaticojejunostomy and jejunal interposition hepaticoduodenostomy after removal of the dilated bile duct. There were no significant differences in the occurrence of early and late complications except for the repeated attacks of abdominal pain that occurred only in the group that underwent jejunal interposition hepaticoduodenostomy. The results of further examinations for the presence of bile reflux with 99mTc-pyridoxyl methyl tryptophan scintigraphy and gastroscopy in this group revealed a high incidence of chronic gastritis associated with bile reflux. This report is the first to demonstrate the occurrence of bile reflux gastritis in patients who underwent jejunal interposition hepaticoduodenostomy, which is theoretically a more logical approach than the other method of bile reconstruction. Further studies, with respect to possible mechanisms, as well as careful and longer follow-up evaluation, are required.