Abstract
In connection with reported higher incidences of gallstone disease (GS) after gastrectomy, we had examined changes in the composition of gallbladder (GB) bile collected through external cholecystostomy from subtotal-gastrectomized dogs with truncal vagotomy. Black stones containing calcium bilirubinate developed in 3/7 gastrectomized dogs but not in 4 external-cholecystostomied control dogs. Analysis of bile suggested that altered bile composition possibly related to bile infection may be a lithogenic factor and that gastrectomy may promote the process of lithogenesis. The high possibility of bile infection through cholecystostomy, however, urged further investigations utilizing canine models without cholecystostomy. Bile was obtained from 5 pylorus-preserving gastrecotmized (PPG), 6 Billroth-II gastrectomized and truncal-vagotomized (B-II) and 6 control (sham operation) dogs by GB puncture during laparotomy at gastric surgery, 6 and 12 postoperative months. Five PPG and 6 control dogs incurred neither bile infection nor GS. Though free bile acids were detected in GB bile from 2/5 PPG dogs, there were no other remarkable changes in bile acids composition in these groups. B-II dogs incurred bile infection in 3/6 (two at 6 months, one at 6 and 12 months) and GS in 3/6. Bile culture was positive for 2/3 dogs with GS. A more marked alteration in bile acids composition was found in B-II dogs compared with those in other two groups. B-II may be more liable to bile infection and subsequent derangement of bile composition with a resultant high incidence of GS.
