The results of reoperation for bile vomiting following surgery for peptic ulcer

A retrospective study is presented of 91 patients (72 male and 19 female) who underwent remedial surgery in the Gastro–intestinal Unit, Western General Hospital, between 1958 and 1972 for bile vomiting following surgery for peptic ulcer. The mean follow–up period was 5.2 years. Fifty-eight (63.8 per cent) patients had undergone a previous gastric resection, 26 (28.5 per cent)a vagotomy and drainage operation and 7 (77 per cent)a gastrojejunostomy alone. At reoperation no abnormality could be found to account for the vomiting in 29 (30.9 per cent)patients, 52 (57.1 per cent) had an obstructed afferent loop, efferent loop or stoma and 6 (6.6 per cent) had acute gastritis only. Twelve (13.2 per cent)patients had a recurrent ulcer. Preoperative barium meal examination and gastroscopy together correcrly indicated the operative findings in 846 per cent of cases. For bile vomiting following Polya gastrectomy 64–68 per cent of those who had a Roux-en- Y conversion or an isoperistaltic jejunal interposition obtained lasting relief of symptoms, as against 55 per cent of patients who had their Polya anastomosis converted to a Billroth Z type. Where the original operation had been a vagotomy and drainage procedure 71 per cent of those converted to a Polya gastrectomy did well, but conversion to a different type of drainage or refashioning of the existing anastomosis was successful in only 40 per cent. The results in 28 patients with a concomitant psychoneurosis were not significantly different from those in the rest of the group.