A firm diagnosis of postoperative reflux gastritis should be established. Endoscopic studies should demonstrate gross as well as microscopic evidence of severe gastritis of greater intensity than is routinely observed from the regurgitation of duodenal contents through an altered gastric outlet. A gastric analysis is performed in a search for evidence of previous complete vagotomy. Barium studies and serum gastrin determination are routinely performed. In addition to a firm clinical diagnosis of postoperative reflux bile gastritis, there should be evidence of persistent symptoms despite long-term intensive medical therapy. The operative procedure is designed to completely divert the duodenal contents away from the gastric outlet. Ulceration will occur unless the gastric acidity is controlled by a complete vagotomy combined with antrectomy.
Constant gastric suction by a nasogastric tube is maintained.