J.Jpn. Surg. Soc.. 92(9): 1288-1291, 1991

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Report on the annual meeting

INTESTINAL MICROFLORA AND BILE ACIDS FOLLOWING BILIARY TRACT RECONSTRUCTION

The purpose of this study was to evaluate the intestinal microflora and the composition of various bile acids in jejunal fluid following B-I and B-II types of biliary reconstruction in dogs. B-1 type reconstruction, in which the biliary tract was directly anastomosed to the food passing tract, was performed in 8 dogs, which received cholecystoduodenostomy (group C-D) and in 8 which received cholecystojejunostomy (group C-J). B-II type reconstruction by Roux-Y cholecystojejunostomy, in which bile flowed into the jejunal limb, was performed in 8 dogs (group R-Y).
Incidences of detection of gram-positive, gram-negative and anaerobic bacteria were as follows : 33%, 33% and 6% the jejunal fluid obtained at initial operation, 67%, 67% and 33% in group C-D, 83%, 67% and 33% in group C-J, and 75%, 88% and 75% in group R-Y.
In six dogs in group R-Y, unconjugated or secondary bile acids in the jejunal fluid increased, while these increases were observed in only two dogs in group C-J and in no dogs in C-D. Unconjugated and secondary bile acids were more likely to increase following B-II type reconstruction than following B-I type reconstruction. These findings are thought to be associated with bacterial overgrowth in the jejunal loop.
These results suggest that B-II type reconstruction, in which bilio-enterostomy is exposed with infected intestinal fluid and unconjugated and secondary bile acids, is inferior in preventing ascending cholangitis.

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