Evaluation of biliary tract reconstruction procedures by analysis of bile acids in the jejunal lumen

The purpose of this study was to evaluate the composition of various bile acids and the presence of anaerobes in jejunal fluid following B-I and B-II biliary reconstruction in dogs. B-I reconstruction, in which bile mixes with ciba, was performed in 16 dogs, including 8 with cholecystoduodenostomy (C-D) and 8 with cholecystojejunostomy (C-J), and B-II reconstruction with Roux-Y cholecystojejunostomy, in which bile flows into the jejunal limb, was performed in 8 dogs (R-Y). In six R-Y, unconjugated bile acids or secondary bile acids in jejunal fluid increased, while these findings were observed in only two C-J and in none of C-D. Unconjugated bile acids and secondary bile acids showed a tendency to increase in B-II, in contrast with B-I. Anaerobes were detected in about 67% of B-II jejunal fluid samples, higher than in B-I jejunal fluic samples. The above-mentioned increase in unconjegated bile acids and secondary bile acids in B-II was thought to be associated with bacterial overgrowth in the jejunal loop. These results suggest that conjegated bile acids, which are essential for fat digestion and absorption, decrease more markedly following B-II recinstruction than following B-I reconstruction, and that B-I reconstruction is superior in preserving the capacity for digestion and absorpation.