Transit disorders of the gastric remnant and Roux limb after Roux-en-Y gastrojejunostomy: relation to symptomatology and vagotomy.

Abstract

Patients after Roux-en-Y gastrojejunostomy frequently complain of upper abdominal pain, fullness, nausea and vomiting. This study was performed to clarify the relationship of this Roux-en-Y syndrome to transit disorders in the gastric remnant and Roux limb, and to vagal status. Using a questionnaire, 35 of 66 patients operated on between 1976 and 1987 were judged to suffer from the Roux syndrome. Gastrojejunal transit was studied by scintigraphy with a solid test meal in 61 patients, 34 of whom were symptomatic. The median (interquartile range) gastric half-emptying time was longer in symptomatic than in asymptomatic patients (79 (43-146) versus 56 (27-79) min, P < 0.05), and in patients with a bilateral vagotomy than in those without a vagotomy (94 (43-225) versus 59 (31-77) min, P < 0.05). Stasis in the Roux limb was observed in 18 of 28 symptomatic and in only three of 27 asymptomatic patients (P < 0.01). The median (interquartile range) fraction of activity emptied from the stomach and remaining in the Roux limb at 60 min was 54 (39-60) per cent in symptomatic patients and 33 (21-40) per cent in those without symptoms (P < 0.01). Stasis in the Roux limb was not related to vagal status. No relationship between slow gastric emptying and Roux-limb stasis was found. Slow gastric emptying, Roux-limb stasis or a combination of both was found in 30 of 34 symptomatic and in only nine of 27 asymptomatic patients (P < 0.01). It is concluded that both slow gastric emptying and Roux-limb stasis can be interpreted as causing the Roux syndrome. Vagotomy seems to be the major cause of slow gastric emptying, but it is not related to stasis in the Roux limb.