Use of the Henley loop for postvagotomy diarrhea

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Postvagotomy diarrhea is rarely a severe problem. Although two thirds of the patients undergoing truncal vagotomy may note a change in bowel habits, less than 1% will experience incapacitating symptoms.1 Most patients with mild or moderate diarrhea after surgery improve with time or respond to low-carbohydrate, dry feedings. A small number of those with more severe diarrhea have nontropical sprue, lactase deficiency, decreased levels of IgA, or parasites. In the remainder, no cause is found.2 Several investigators have found that the concentration of bile acids in the stool is increased in patients with severe postvagotomy diarrhea.3 Explanations have included increased dumping of bile salts into the intestine from a flabby, denervated gallbladder as proposed by Condon et al,4 although the syndrome has occurred in cholecystectomized patients. Additional explanations include malfunction of a denervated ileocecal valve as suggested by Scarpello and Sladen,5 malabsorption of bile salts with increased intestinal transit time, or an increased production of bile salts in the liver. Cholestyramine has been shown to be helpful in some cases.4–8 Some patients do not respond to any standard attempts to control diarrhea and require surgical intervention. We report two cases of disabling postvagotomy diarrhea corrected by the construction of a Henley isoperistaltic jejunal loop.

Case reports

Case 1. A 51-year-old man was first examined at the Cleveland Clinic in December 1974. He complained of having five to nine bowel movements per day with severe post-prandial, midepigastric, and hypochondrial pain. He had lost 28.8 kg (64 pounds) over the preceding . . .



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