Motility in the Hunt-Lawrence pouch after total gastrectomy.
OBJECTIVE
The aim of this study was to evaluate motility patterns of the Hunt-Lawrence pouch and the jejunal limb of patients reconstructed with a pouch after total gastrectomy, and to compare the findings in symptomatic patients to those without symptoms after the operation.


METHODS
Thirty-three patients who had undergone post-gastrectomy pouch reconstruction were studied using a water-perfused motility system. In 21, the pouch was connected by a Roux-en-Y, and, in 12, by a jejunal interposition. Twenty-eight patients were asymptomatic, including 17 connected by a Roux-en-Y and 11 by a jejunal interposition. Five patients were by a jejunal interposition. Five patients were symptomatic, including 4 connected by Roux-en-Y Y and 1 by jejunal interposition. A control group consisted of 5 healthy volunteers who had not undergone operation.


RESULTS
The motility phases in the pouch and jejunal limb of asymptomatic patients were of shorter duration than those of controls, and they followed a random sequence instead of a normal progression from phase I to II to III. Motility features were similar in the pouch and the jejunal limb. Orthograde propagation of phase III-like activity was reduced and may contribute to the pouch storage function. Four of the 5 symptomatic patients showed highly abnormal motility with hypomotile or obstructive patterns. The technique of connecting the pouch--jejunal interposition of Roux-en-Y--did not affect the motility findings.


CONCLUSIONS
The altered motility occurs after a Hunt-Lawrence pouch reconstruction in asymptomatic patients. Symptoms after gastrectomy are associated with further disturbed motility that can be differentiated from the motility changes in asymptomatic patients.
Department of Surgery, University of Southern California, School of Medicine, Los Angeles 90033-4612.
J
J
Heimbucher
K H
KH
Fuchs
S M
SM
Freys
G W
GW
Clark
R
R
Incarbone
T R
TR
DeMeester
C G
CG
Bremner
A
A
Thiede
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D005260:Female; D005743:Gastrectomy; D005769:Gastrointestinal Motility; D006801:Humans; D007583:Jejunum / Q000502:physiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period