Biliary Tract Disease Following Billroth II Subtotal Gastrectomy

The development of gallbladder disease in some of our patients who previously had subtotal gastrectomies has been noted. Most of these procedures were performed for complicated duodenal ulcers and have been the Billroth II (Polya-Lahey modification) type of anastomosis. It is in general acceptance that upon the entrance of fatty food and gastric secretions into the duodenum, this part of the intestine, and also the upper jejunum, liberates a hormone, called cholecystokinin, which will produce contraction of the gallbladder and, at the same time, relaxation of the sphincter of Oddi.³ After a gastrectomy with a Billroth II type of anastomosis, the anatomy of the stomach and proximal intestine is completely changed, and fatty food or gastric secretions will not come in contact with the duodenal mucosa; however, ingestion of a fatty meal by a gastrectomized person following a preparation with iopanoic (Telepaque) tablets causes varying degrees of contraction and