Hepatobiliary and gastrointestinal imaging after pancreaticoduodenectomy--a comparative study on Billroth I and Billroth II reconstructions.

This study was conducted to compare the passage of bile and food through the remnant alimentary tract between 2 and 6 months following pancreaticoduodenectomy in patients undergoing Billroth I (Imanaga) and Billroth II (Child) reconstructions, using dual scintigraphy. In the patients who underwent Child's operation (n = 14), hepatobiliary scintigraphy showed a prominent stasis of bile tracer in the proximal jejunal loop and a significant time delay before the bile and food became mixed at the upper jejunum. On the other hand, in the patients who underwent Imanaga's operation (n = 9) no bile stasis in the proximal jejunal loop was found and the time taken before the two agents became mixed was similar to that of healthy controls (n = 7). The time taken for the two agents to mix at the upper jejunum was 65.8 +/- 7.9 min in the patients after Child's operation, 17.3 +/- 2.5 min in those after Imanaga's operation, and 18.5 +/- 2.8 min in the healthy controls, respectively. Continuous stasis of bile in the proximal loop and severe postcibal asynchronism in patients who undergo Child's operation can therefore cause reflux cholangitis and absorptive disturbances in the long postoperative term. The results of this study suggest that Imanaga's reconstruction is a more physiological procedure than Child's reconstruction following pancreaticoduodenectomy.