DOI: 10.36347/SASJS.2019.v05i10.006

Pages: 400-404

Introduction: Triple bypass surgery for an unresectable carcinoma periampullary region need gastric and biliary bypass. These patients frequently have bile reflux into the stomach. This aspect in triple bypass is not frequently discussed. Patients and Methods: All patients subjected to triple bypass from 2012 to 2017 were included in the study. For initial four years the traditional method of Roux En Y Triple bypass (RYHJ) was used and subsequently in last 4 years the method was changed in which is referred to as Jaipur loup. All patients had been observed for symptoms of bile reflux clinically. UGI endoscopy was done as a routine in all patients in study group. Results: Total 23 patients had undergone triple bypass. 17 in group 1 and 6 in group 2. Of the 17 patients 3 had vomiting and 5 had reflux gastritis like symptoms in post operative period. None of the 3 patients with vomiting had hold up of bile on oral contrast study. On UGI endoscopy all 3 with vomiting and two with symptoms of reflux had severe bile reflux. In group 2 (with Jaipur loup) with modified anastomosis none had symptoms of vomiting or reflux. At UGI endoscopy none had finding of bile refluxing. Conclusion: Patients with gastrojejunostomy in the proximal limb 10 from Duodenojejunal junction and having jejunojejunostomy 10 cm distal to duodenojejunostomy site have rapid post operative recovery with no bile reflux.