title: Myoelectric effects and histology after stapled occlusion of the small bowel.
abstract: Braun enteroenterostomy with stapled occlusion of the afferent limb has been advocated to treat bile gastritis and to avoid the motility effects of Roux-en-Y gastrojejunostomy. However, the motility effects of stapled occlusion are unknown. Myoelectric activity and histologic features were studied after stapled occlusion of the small bowel in a canine model. A 35 cm "recirculating loop" was created with a side-to-side anastomosis, beginning 25 cm from the ligament of Treitz. Serosal electrodes were placed at 5 cm intervals on the loop; at a second operation in one dog and simultaneously in three dogs, the bowel was occluded midway between two electrodes with 4.8 mm staples. Fasting recordings were obtained at weekly intervals to 6 months after surgery and were analyzed for slow wave frequency proximal and distal to the staple line and for propagation time of phase 3 of the migrating myoelectric complex across the staple line. The side-to-side anastomosis did not alter myoelectric activity. However, after stapled occlusion of the small bowel, the slow wave frequency dropped from a mean of 18.2 +/- 0.4 cpm proximally to 15.4 +/- 1.0 cpm distally (p less than 0.05). This correlated with loss of myogenic continuity in three of four animals. Propagation of phase 3 slowed across the staple line (115 +/- 27 seconds versus 47 +/- 9 seconds) (p less than 0.02). The bowel lumen recannulated in all animals. Stapling across the small bowel alters myoelectric activity, and occlusion of the bowel lumen may not be permanent.
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville.
authors.forename: M P
authors.initials: MP
authors.lastname: Hocking
authors.forename: W D
authors.initials: WD
authors.lastname: Harrison
authors.forename: S B
authors.initials: SB
authors.lastname: Vogel
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D000818:Animals; D004285:Dogs; D005260:Female; D007421:Intestine, Small / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D016065:Myoelectric Complex, Migrating; D010528:Peristalsis; D013528:Surgical Staplers