Gastric Stasis of Solids after Roux Gastrectomy: Is the Jejunal Transection Important?

Abstract

To investigate the effect of jejunal transection on the rate of gastric emptying after Roux gastrectomy, a two-part study was conducted. First, we investigated the relationship between Roux limb slow wave frequency and gastric emptying of solids. Six dogs underwent Ronx-en-Y gastrectomy with vagal preservation and placement of intestinal electrodes. Gastric emptying studies were performed on each animal with simultaneous pacing of the Roux limb, either at the slowest rate ( P min) or the fastest rate ( P max) at which entrainment could be achieved. Gastric emptying studies were also performed in the unpaced (control) condition. Gastric half-emptying times ( X̄ ± SEM minutes) and slow wave frequencies ( X̄ ± SEM cycles per minute), respectively, were P min 117 ± 26 min, 15.7 ± 0.1 cpm; P max 97 ± 18 min, 19.0 ± 0.3 cpm; and unpaced 127 ± 16 min, 15.1 ± 0.3 cpm. The gastric half-emptying time during P max was significantly lower than unpaced controls ( P = 0.01). The second part of the study sought to determine if transecting the intestine at 10 cm distal to the pylorus rather than at 20 cm distal to the ligament of Treitz would improve gastric emptying in animals with a truncal vagotomy and Roux-en-Y gastrectomy, Gastric half-emptying times were 149 ± 21 and 164 ± 24 min (ns), respectively. Slow wave frequencies were 17.01 ± 0.06 and 15.7 ± 0.17 cpm ( P < 0.05), respectively. The Roux limb with the more proximal transection converted to the normal fed state pattern on 10 of 15 recording sessions, whereas the group with the more distal transection converted on 5 of 24 recording sessions ( P < 0.05). In conclusion, the decrease in Roux limb slow wave frequency following Roux-en-Y gastrectomy contributes to delayed gastric emptying. Although performing the transection more proximally slightly increases Roux limb slow wave frequency, this alone is insufficient to significantly improve the rate of gastric emptying of solids.