Alteration of the Roux Stasis syndrome by an isolated Roux limb: correlation of slow waves and clinical course.
The Roux-Y stasis syndrome after antrectomy and vagotomy has been well described. Delayed gastric emptying after vagotomy and antrectomy with Roux-Y anastomosis has been attributed to loss of the duodenal pacemaker and to the effects of retrograde slow-wave activity arising from distal small bowel pacemakers. Small bowel contractions are closely coupled with slow-wave activity. Transection and anastomosis of the small bowel distal to the jejuno-jejunostomy has been shown to electrically isolate the Roux limb from distal small bowel pacemakers. Using a canine model, a vagotomy and hemigastrectomy with Roux-Y were performed in five dogs using the standard operation (control); in four dogs (experimental), an additional transection and reanastomosis of the jejunum 25 cm distal to the Y anastomosis of the Roux limb was performed. All specimens had six electrodes implanted along the Roux limb at 5-cm intervals, used for weekly analysis of the jejunal slow-wave activity. The isolated loop cohort had reduced incidence of retrograde slow waves, reduced emesis, improved gastric emptying by upper gastrointestinal series, and reduced gastric pouch size at autopsy. Adding a distal transection and anastomosis, thus creating an isolated Roux-Y segment, may improve the course of the Roux stasis syndrome.
St. John Hospital and Medical Center, Detroit, Michigan, USA.
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Zonca
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Rizzo
D000713:Anastomosis, Roux-en-Y / Q000379:methods; D000818:Animals; D004285:Dogs; D005260:Female; D005769:Gastrointestinal Motility; D005774:Gastrostomy / Q000379:methods*; D007582:Jejunostomy / Q000379:methods; D007583:Jejunum / Q000502:physiology*; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D013577:Syndrome; D014628:Vagotomy / Q000379:methods*