[Ulcer risk in the Roux-Y stomach. An animal experiment study].
The ulcer risk of the Roux-Y anastomosis following gastric resection was analyzed experimentally in 82 rats. After 1/3 gastric resection a Roux-Y gastrojejunostomy with jejunal loops of 3, 6, 9 and 15 cm was performed. 10 months postoperatively a follow-up was performed consisting of endoscopy, measurement of pH-values, analysis of gastric secretion and serum gastrin, gastric emptying tests and histamine stimulation. Endoscopically there was a high rate of stomal ulceration related to the length of the jejunal loop. In long Roux-Y loops (9 and 15 cm), that means under reflux-free conditions, ulcer incidence ranged from 72% to 92%. In short loops with reflux-exposed stomachs the frequency of ulceration was only 9%. With additional histamine stimulation there were stomal ulcers in 100% of the reflux-free animals, but only in 60% of the rats with short Roux-Y loops. In spite of resection acidity was high (pH 1.8) in reflux-free stomachs. Only the volume of gastric secretion and the amount of acid-output was reduced. Gastric acid secretion unbuffered by duodenal content is discussed as the major factor in the etiology of stomal ulcer in reflux-free stomachs. So the Roux-Y anastomosis following gastric resection is a modification of the Mann-Williamson experiment. Therefore reflux-free operations are heavily ulcer prone.
D000818:Animals; D005743:Gastrectomy / Q000379:methods*; D005745:Gastric Acidity Determination; D005746:Gastric Emptying; D005753:Gastric Mucosa / Q000473:pathology; D005755:Gastrins / Q000097:blood; D007413:Intestinal Mucosa / Q000473:pathology; D007583:Jejunum / Q000473:pathology / Q000601:surgery; D008297:Male; D011178:Postgastrectomy Syndromes / Q000473:pathology*; D051381:Rats; D011919:Rats, Inbred Strains; D012306:Risk; D013276:Stomach Ulcer / Q000473:pathology*; D014629:Vagotomy, Proximal Gastric
D005755:Gastrins
Das Ulcus-Risiko des Roux-Y Magens. Eine tierexperimentelle Studie.