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Alkaline reflux gastritis is being recognized with increasing frequency after operations that ablate the pylorus as a true sphincter. Medical management is generally ineffective for patients with severe reflux gastritis, but Roux-en-Y diversion of bile and of pancreatic and intestinal secretions provides gratifying results. We studied 100 patients who underwent remedial operation. Roux-en-Y gastrojejunostomy or Tanner's vs Roux-19 procedure gave good to excellent results in most of the 73 patients followed up for from one to six years. Reflux gastritis can occur in association with other postgastrectomy disorders. Fifteen patients with reflux gastritis also had severe dumping or postvagotomy diarrhea. Good to excellent results were obtained in most of these patients by Roux-en-Y diversion combined with an antiperistaltic jejunal segment.

During routine cholecystectomy, a 39-year-old woman suffered an injury to the common bile duct, which resulted in a choledochal stricture and a choledochopancreatic fistula with pseudocyst formation. Treatment consisted of a choledochoduodenostomy for the common bile duct stricture and a pancreaticoduodenostomy for internal drainage of the pancreatic pseudocyst. A long-term follow-up has yielded an excellent clinical result.