Roux Stasis Research Articles

Novel application of GI electrical stimulation in Roux stasis syndrome (with video)

About one-third of patients undergoing a Roux-en-Y anastomosis develop Roux stasis syndrome, likely because of disordered electrical conduction. GI electrical stimulation has been previously used successfully in the management of postsurgical gastroparesis. Endoscopic placement of temporary electrodes and GI electrical stimulation in the management of severe Roux stasis syndrome in a patient with esophagojejunostomy and to determine whether the patient would be a candidate for surgical permanent electrode placement. Case report. Academic medical center. This study involved a patient with Roux stasis syndrome. Upper endoscopy was performed, followed by endoscopic placement of two temporary electrodes, one each in the two jejunal limbs. Electrical stimulation was provided by an external stimulation device. The patient was re-evaluated 5 days later. Electrogastrogram (EGG) parameters including frequency, amplitude, and frequency-amplitude ratio and total symptom score and health-related quality of life score. There was a significant improvement in EGG parameters with electrical stimulation. Also, the patient had a marked improvement in total GI symptom score, from 11 to 4, with a dramatic improvement in the health-related quality of life score from -3 to +3. Single case report. Endoscopic placement of temporary electrodes is feasible and safe. GI electrical stimulation of the jejunal limb is a potentially effective treatment for Roux stasis syndrome.

Double stapling Roux-en-Y reconstruction in a laparoscopy-assisted distal gastrectomy

The purpose of this study is to introduce the technical details of double stapling Roux-en-Y (R-Y) reconstruction and evaluate its short-term results. Twenty-three patients who underwent a laparoscopy assisted distal gastrectomy with R-Y reconstruction between May 2007 and December 2008 were enrolled in this study. This investigation analyzed the clinicopathological data, the surgical data, and the postoperative outcome. There were 14 males and 9 females, and the mean age was 60.1 years (range, 51-66 years). The mean number of the retrieved lymph nodes was 37.3 (range, 17-67), and stage IA in 22 patients and stage IB in 1 patient. The total operation time was 198.3 min (range, 165-210 min), the intracorporeal operation time was 118.0 min (range, 95-130 min), and the extracorporeal operation time was 80.2 min (range, 70-90 min). The mean length of the incision was 3.5 cm (range, 3.2-3.8 cm). There was no leakage, stricture, or Roux stasis syndrome, and 3 cases (13%) of remnant gastritis occurred postoperatively. Double stapling R-Y anastomosis can be performed easily, quickly, and safely, and it is particularly useful in a laparoscopy-assisted distal gastrectomy. This method is advantageous in terms of the operation time and the cost effectiveness.

Laparoscopic reversal of gastric bypass with sleeve gastrectomy for treatment of recurrent retrograde intussusception and Roux stasis syndrome

Background We reported on our experience of 23 patients with retrograde intussusception (RINT) in 2007. That series has increased to 54 patients. Surgical resection of the jejunojejunostomy appears to be the most effective treatment. We treated 8 patients with documented or suspected recurrent RINT despite resection, by reversing their gastric bypass with sleeve gastrectomy to avoid weight regain. Methods The medical records of 8 patients who had undergone treatment of suspected recurrent RINT with reversal of their gastric bypass followed by sleeve gastrectomy were reviewed to evaluate the outcomes, complications, weight loss, and relief of symptoms. Results All 8 patients were women, aged 29–56 years. The mean body mass index at reversal was 22.3–36.5 kg/m 2 (mean 30). The follow-up period was 1–28 months (mean 20.8). The body mass index at the last visit was 21.3–33 kg/m 2 (mean 26). Complications occurred in 5 patients. Patient 1 developed delayed splenic bleeding that required splenectomy on the second postoperative day. Patient 2 developed a gastric fistula 6 weeks after surgery after dilation. Patient 4 developed a superior mesenteric vein thrombosis at 2 weeks postoperatively. Patient 7 developed a proximal small bowel obstruction. Also, 4 patients required dilation of the gastrogastrostomy. At the last follow-up visit, the patients did not have symptoms of recurrent RINT and had not regained their weight. Conclusion Laparoscopic reversal of gastric bypass with sleeve gastrectomy for recurrent RINT or RINT-like symptoms (Roux stasis symptoms) resulted in a significant risk of complications in this small group of patients but appears to be effective for relieving the symptoms of RINT with minimal risk of weight regain, at least in the medium term.

Long-Term Results of the Cut-Closed-Reconnected Roux Loop for Enterogastric Reflux

Background: The aim of this study was to present the long-term results of the cut-closed-reconnected (CCR)-Roux procedure for reflux gastritis. Methods: A retrospective analysis was performed on 14 patients with proven reflux gastritis and/or esophagitis who were treated at our institution with a CCR-Roux procedure between 1992 and 1997. Results: The closure of the afferent loop in the CCR-Roux procedure is effective and permanent. The CCR-Roux patients did not need a rest gastrectomy. No signs of Roux stasis syndrome were seen. There was a consistent weight gain at 2 and 5 years of follow-up. These results permit a comparison with those of the Roux-Y procedure and other alternative procedures as well. Conclusion: In the long run, the CCR-Roux procedure is effective in the treatment of reflux gastritis.

Uncut Roux-en-y esophagojejunostomy: A new reconstruction technique after total gastrectomy

Uncut Roux-en-y is a reconstruction method with a main purpose of diminishing Roux stasis syndrome. In this study we performed this procedure to evaluate utility and complications of this technique, as well as its effect on Roux stasis syndrome. Total gastrectomy with Uncut Roux-en-y esophagojejunostomy was performed on 94 patients. This technique consists of an artificial jejunal occlusion 5 cm proximal to anastomosis and a jejunojejunostomy between afferent and efferent loops. Diagnosis of "Roux stasis syndrome" was made by clinical criteria. According to the mentioned criteria, the "Roux stasis syndrome" occurred in 21.2% of the patients. Whereas occurrence rate of other complications was: dysphasia (13.8%), benign stricture in anastomosis (9.6%), and fistula (5.3%). Comparing the results of our study to other related studies indicates that this type of operation has lower rate of "Roux stasis syndrome", and also decreases the postoperative stricture rate of the anastomosis.

The advantages and disadvantages of a Roux-en-Y reconstruction after a distal gastrectomy for gastric cancer

In Japan, the Billroth I and Billroth II operations have been used for reconstruction after a distal gastrectomy for gastric cancer. However, a Roux-en-Y reconstruction is increasingly performed to prevent duodenogastric reflux. We herein discuss the indications for Roux-en-Y in gastric surgery and review the literature to determine its advantages and disadvantages. Indications for Roux-en-Y reconstruction after a distal gastrectomy are: (a) When the primary lesion has directly invaded the duodenum or head of the pancreas, the Billroth I operation is likely to result in local recurrence near the anastomosis; (b) in addition, the Billroth I operation is not indicated after a subtotal gastrectomy due to an unacceptable anastomotic tension; reconstruction using a nonphysiological route is therefore preferred. The advantages of Roux-en-Y reconstruction after a distal gastrectomy include a reduction of reflux gastritis and esophagitis, a decreased probability of gastric cancer recurrence, and a reduction in the incidence of surgical complications such as ruptured suture lines. The disadvantages of Roux-en-Y reconstruction include the possible development of stomal ulcer, an increased probability of cholelithiasis, increased difficulty with an endoscopic approach to the ampulla of Vater, and the possibility of Roux stasis syndrome. The principal advantage of a Roux-en-Y reconstruction is that it is less likely than the Billroth I operation to result in duodenogastric reflux. Roux-en-Y reconstruction or Billroth I operation can only be selected after considering their respective advantages and disadvantages.

Clinical study on the alimentary canal reconstruction of uncutted Roux-en-Y with jejunal pouch for total gastrectomy

To investigate the efficacy of uncutted Roux-en-Y esophagojejunostomy with jejunal pouch (URYJP) after total gastrectomy. Total gastrectomy was performed on 168 patients of gastric cancer, and 3 methods were used for reconstruction: the uncutted Roux-en-Y esophagojejunostomy with a jejunal pouch was performed on 69 patients(group A),Roux-en-Y esophagojejunostomy with the P-type jejunal pouch on 50 patients(group B),and Roux-en-Y esophagojejunostomy with the Orr-type jejunal pouch on 49 patients (group C). The alimentary tract reconstruction time, morbidity and mortality were compared. The 121 cases that survived for more than 1 year were analyzed for quality of life(QOL),including body weight, intake quantity, prognosis nutritional index (PNI), and Visick scores 6 and 12 months after the operations. All the patients recovered quickly and no anastomosis leakage or duodenal fistulas were found. It took (30+/-7) minutes to finish the reconstruction in group A, which was significantly shorter than that in group B [(57+/-6) minutes] or in group C [(48+/-6) minutes]. There were no significant differences among 3 groups in the incidence of alkaline reflux gastritis. The incidence of Roux stasis syndrome was 2.2% in group A, which was significantly lower than 17.9% and 19.4% in group B and C. Weight loss and food intake gain in group A was superior to those in group B and C 6 months and 12 months postoperatively. As compared with prognosis nutritional index(PNI) postoperatively, those of 3 groups decreased significantly 6 months postoperatively. At 12 months after operation, the PNI of group A returned to the level before operation, while PNI of both group B and C remained significantly lower than those before operation (both P < 0.05). The Visick score of group A was superior to those of group B and C 6 months and 12 months postoperatively. The new uncutted Roux operation with jejunal pouch can prevent alkaline reflux gastritis and Roux-en-Y stasis syndrome. It may be a standard procedure for reconstruction after total gastrectomy.

The uncut Roux-en-Y with jejunal pouch: a new reconstruction technique for total gastrectomy

Roux Stasis Syndrome is a well-known complication after Roux-en-Y reconstruction. It has been hypothesized that reconstruction with an uncut Roux limb and jejunal pouch after total gastrectomy would preserve unidirectional intestinal myoelectrical activity, improve postoperative weight gain and nutritional parameters, and diminish Roux Stasis Syndrome in canines. A total gastrectomy was performed, and 2 methods were used for reconstruction: Roux-en-Y esophagojejunostomy (RY) was performed on 5 canines (control), and the uncut Roux-en-Y with a jejunal pouch (URYJP) was performed on 5 other canines (experimental). The canines were monitored for 10 weeks postoperatively. Serial weight and nutritional parameters were measured. Emptying profiles and motility studies were performed in the fasting and postprandial states. Ten weeks after operation, the URYJP group had significantly improved nutritional parameters, including weight, total protein, albumin, hemoglobin, serum total iron binding capacity, and serum IgA, IgG, and IgM. The emptying times for both groups were similar, with an increase of disordered propagation of the jejunal pacesetter potential in the RY group. The aboral propagation occurred more frequently in the URYJP group during fasting and after feeding (98% +/- 1% vs 39% +/- 16%; P = .02, and 99% +/- 1% vs 43% +/- 18%; P = .03). The sites of luminal occlusions were intact in the URYJP group at 10 weeks. The combination of jejunal pouch and uncut Roux limb improved overall nutritional parameters when compared with the traditional Roux-en-Y, while preserving aboral propagation of jejunal pacesetter potentials.

Comparison of an Uncut Roux-en-Y Gastrojejunostomy with a Billroth I Gastroduodenostomy after Totally Laproscopic Distal Gastrectomy

Purpose: An uncut Roux-en-Y gastrojejunostomy has been known to be effective in preventing bile reflux gastritis in the remnant stomach and the Roux stasis syndrome. Materials and Methods: To evaluate the usefulness of a totally laparoscopic uncut Roux-en-Y gastrojejunostomy (TLuRYGJ) after a distal gastrectomy, we reviewed the medical records of 19 consecutive patients that underwent a TLuRYGJ at our institution, and 11 consecutive patients who underwent a totally laparoscopic Billroth I gastrectomy (TLB-I) during the same period. Results: Postoperative gastrointestinal symptoms related to the postgastrectomy syndrome and the Visick classification at six months after surgery were not different in the two groups; however, there was no case of symptomatic bile reflux gastritis and only one case of delayed gastric empting, for which medication was required, in the TLuRYGJ group. The endoscopic findings of the remnant stomach for bile reflux gastritis at six months after surgery were better in the TLuRYGJ group than in the TLB-I group. Conclusion: A TLuRYGJ was found to be effective in preventing bile reflux gastritis and the Roux stasis syndrome.

Alkaline Reflux Gastritis: Early and Late Results of Surgery

Alkaline gastritis is caused by excessive reflux of alkaline duodenal content into the stomach or gastric remnant following procedures that resect or de-functionalize/deviate the pyloric sphincter. The symptoms may be intractable and surgery may be required in a selected subgroup of patients. The goal of this study was to present our experience regarding surgical management of alkaline reflux gastritis. During a 15-year period, 26 patients underwent surgery for the management of refractory alkaline reflux gastritis. Preoperative evaluation included a detailed history, endoscopy, and histology; alkaline reflux gastritis was characterized as mild, moderate, or severe based on the results of this evaluation. The patients underwent remedial gastric surgery when conservative management was ineffective and the patient's symptoms-despite medical treatment-persisted for at least 2 years and affected quality of life. Most patients had previously undergone subtotal gastrectomy/gastrojejunostomy (the Billroth II procedure) (22/26, 84.6%); three patients (11.5%) had vagotomy and gastrojejunostomy, and 1 patient (3.9%) had vagotomy and pyloroplasty. In most patients (14/26, 54%), symptoms appeared 1-3 years after initial gastric surgery. Epigastric pain and bilious vomiting were reported by all (26/26, 100%) and by 25/26 (96%) of patients, respectively, while anemia and weight loss were observed in 11/26 (42.3%) and 18/26 (69.2%), respectively. Severe, moderate, and mild gastritis was present in 12, 9, and 5 patients, respectively. Most patients (18/26, 69%) were treated by Roux-en-Y anastomosis, and 8 (31%) by the Tanner (Roux-19) procedure. Long-term follow-up was completed in 23 patients (mean: 7.3 years), by clinical assessment (n=18), or by questionnaire (n=5). Results were assessed by using the Visick grading. One patient died from massive pulmonary embolism (mortality: 3.8%). Morbidity was 57%, with the Roux stasis syndrome being the most frequent complication (n=9). Both procedures achieved good early results, particularly regarding pain relief and absence of vomiting (84% and 96%, respectively). Endoscopic findings were ameliorated 6 months following surgery, whereas histological changes remained relatively unchanged. Eleven patients (47.8%) reported excellent (Visick I), 9 (39.2%) good, and 3 (13%) unsatisfactory late results. Remedial gastric surgery was effective and achieved symptom relief in a significant percentage (87%) of our patients. The Roux stasis syndrome is a frequent complication following Roux-en-Y reconstruction, but quality of life is significantly improved. Careful patient selection is essential to achieve satisfactory results.

Laparoscopy-assisted uncut Roux-en-Y operation after distal gastrectomy for gastric cancer

In order to prevent the Roux stasis syndrome that sometimes follows Roux-en-Y gastrojejunostomy after distal gastrectomy, a new type of reconstruction, called the uncut Roux-en-Y technique, has been reported. We successfully performed 42 laparoscopy-assisted uncut Roux-en-Y gastrojejunostomies. Here we describe our technique and the initial outcome.

Roux Stasis Syndrome in Conventional Roux-en-Y Gastrojejunostomy and Uncut Roux-en-Y Gastrojejunostomy after Subtotal Gastrectomy

Purpose: Roux stasis syndrome is the main complication of a Roux-en-Y gastrojejunostomy. The aim of this study was to compare the occurrence rate of Roux stasis syndrome with the passing of time in a conventional Roux-en-Y gastrojejunostomy and in an uncut Roux-en-Y gastrojejunostomy. Materials and Methods: 50 patients (31 men and 19 women) had a conventional Roux-en-Y reconstruction and 53 patients (35 men and 18 women) had an uncut Roux-en-Y reconstruction. The Roux stasis syndrome was defined by clinical criteria only. The criteria included one of the four following conditions at the time of follow-up: chronic upper abdominal pain, postprandial fullness, persistent nausea, and intermittent vomiting that are worsened by eating. Follow-up after surgery was done in all patients at , and months. Results: According to the criteria, the Roux stasis syndrome occurred in 40.0 of the patients at 712 months, 33.3 at months, at months, at months, and at months after a conventional Roux-en-Y operation. The syndrome occurred in of the patients at months, at months, at months, at months, and at months after an uncut Roux-en-Y reconstruction. Conclusion: In terms of occurrence pattern, only a little variance existed one year after both procedures. Comparing the Roux stasis syndrome in both procedures, the uncut Roux operation had better results than the conventional Roux operation.

Teflon buttress inhibits recanalization of uncut stapled bowel

The uncut Roux limb operation is designed to have the benefits of a Roux limb but still have electrical continuity from proximal to distal bowel, thus eliminating the risk of Roux stasis syndrome. The main complication has been recanalization of the uncut staple line leading to bile reflux. This study aims to employ a new technique, which will not allow recanalization of an uncut staple line but will not interfere with normal bowel myoelectric activity. Fourteen mongrel dogs, 25 to 35 kg, underwent a midline laparotomy under general anesthesia. An uncut staple line was placed 25 cm from the ligament of Treitz. In seven animals an uncut staple line alone was placed, and in the other seven animals the bowel was stapled between a sandwich of Teflon reinforcing strips such that the staples were held on both sides of the bowel by the Teflon. A jejunojejunostomy was placed 6 cm proximal to the staple line. Insulated bipolar electrical leads were placed around the staple line. After the electrical leads were monitored 2 days to 3 months postoperatively for bowel myoelectric activity, the animals were killed and the operative sites inspected. No animal suffered morbidity or mortality from the procedure. All seven unreinforced staple lines recanalized and all seven reinforced staple lines remained competent. The duodenal pacemaker potentials were transmitted through the staple line in five animals (3 controls and 2 with Teflon reinforcement) within 1 week postoperatively. The uncut staple line does not reliably transmit the duodenal pacemaker potentials. The staple line does not recanalize when it is reinforced with a permanent material, increasing the utility of the “uncut” Roux limb operation.

Improvement of the Roux limb function using a new type of “uncut Roux” limb

Background: The Roux stasis syndrome is characterized by symptoms of upper gut stasis following Roux-en-Y gastrojejunostomy. The aim of this study was to compare a new type of uncut Roux-en-Y gastrojejunostomy with the conventional Roux-en-Y gastrojejunostomy after subtotal gastrectomy. Methods: 51 patients (31 men and 20 women) had the conventional Roux-en-Y reconstruction and 54 patients (38 men and 16 women) had the new type of uncut Roux-en-Y reconstruction. The new type of uncut Roux-en-Y gastrojejunostomy consisted of an artificial jejunal occlusion and a short Roux limb (20 to 30 cm). Results: The criteria included one of the four following conditions at the time of follow-up: chronic abdominal pain, postprandial fullness, persistent nausea, and intermittent vomiting that are worsened by eating. According to the criteria, the Roux stasis syndrome occurred in 19 patients (37.3%) with conventional Roux-en-Y reconstruction, and in 10 patients (18.5%) with uncut Roux-en-Y reconstruction ( P = 0.033). Conclusions: A new type of Roux operation is able to alleviate not only the Roux stasis syndrome but also alkaline reflux gastritis or esophagitis by preserving motility of the Roux limb and diversion of duodenal juice from the gastric remnant.

Standard Roux-en-Y gastrojejunostomy vs. “uncut” Roux-en-Y gastrojejunostomy: a matched cohort study

Roux-en-Y gastrojejunostomy is a common method of reconstruction after subtotal gastrectomy. Maintaining myoneural continuity has been proposed to decrease the incidence of Roux stasis syndrome, with an “uncut” Roux-en-Y reconstruction. The aim of our study was to compare the clinical results in patients who have undergone uncut Roux-en-Y gastrojejunostomy with those in patients who have undergone a standard Roux-en-Y gastrojejunostomy. Eleven patients underwent gastrectomy and uncut Roux-en-Y gastrojejunostomy and were compared with a cohort of 14 patients who underwent gastrectomy and standard Roux-en-Y gastrojejunostomy. Patients were contacted and charts were reviewed for Visick grade, early and late morbidity and mortality, and incidence of staple line dehiscence. Early postoperative morbidity was 18% in patients undergoing uncut Roux gastrojejunostomy and 28% in patients undergoing standard Roux reconstruction. There were no early postoperative deaths in either group. In the patients undergoing the uncut Roux procedure, no cases of staple line dehiscence were detected clinically (mean follow-up 9 months, range 1 to 48 months). Visick grade improved following the uncut Roux procedure, but changed little after standard Roux reconstruction. Uncut Roux-en-Y gastrojejunostomy can be performed safely with improvement in symptoms. The uncut Roux procedure may provide an alternative for reconstructive gastric surgery.

Surgical treatment of Roux stasis syndrome

We wondered whether the slow gastric emptying of the Roux stasis syndrome could be improved by performing a corrective “uncut” Roux operation. Five dogs had a standard Roux gastrectomy and placement of serosal electrodes on the proximal jejunum and Roux limb. After recovery, baseline myoelectrical and gastric emptying data were collected. The animals then underwent a second operation: take down of the Roux limb, restoration of jejunal continuity, and construction of an “uncut” Roux limb. After the animals recovered, the tests were repeated. The slow frequency of pacesetter potentials (PPs) in the standard Roux limb (mean ± standard error of the mean 14 ± 0.4 cpm) was unchanged after the uncut Roux operation (14 ± 0.5 cpm, P >0.05). However, a greater percentage of PPs propagated aborally in the uncut Roux limb (81% ± 4%) than in the standard Roux limb (53% ± 7%, P <0.05). Nonetheless, gastric emptying of a 250 ml 10% dextrose liquid meal was not speeded by the uncut Roux operation (uncut Roux = 36% ± 5% emptied by 20 minutes vs. standard Roux = 35% ± 7%; P >0.05). Bile acid concentrations in gastric aspirates were minimal after both operations (0.7 ± 0.2 μmol/L vs. 0.6 ± 0.1 μmol/L; P >0.05). The conclusion was that more PPs propagated in the aborad direction in the uncut Roux limb than in the standard Roux limb, but gastric emptying was not speeded by the uncut Roux operation. Both operations were equally effective in preventing bile reflux into the gastric remnant.

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.

Surgery of the small bowel

This review deals with several topics of interest, including ileal pouch-anal anastomosis, pouch salvage surgery, stricture-plasty, and the use of laparoscopy in the management of inflammatory bowel disease. The management of small bowel obstruction is discussed. New insights are offered on the causation of Roux stasis syndrome. Factors influencing the healing of small bowel anastomoses are reviewed. Adaptive changes that occur with the short bowel syndrome are described. Finally, the current experience with small bowel transplantation is highlighted.

Elimination of the Roux stasis syndrome using a new type of “uncut Roux” limb

Background: The Roux stasis syndrome, a syndrome of nausea, vomiting, abdominal pain, and postprandial fullness that follows Roux-en-Y gastrojejunostomy, is thought to result from the jejunal transection performed during the construction of a conventional Roux limb. The purpose of this study was to test a new type of “uncut” Roux limb construction, in which a neuromuscular bridge maintains neuromuscular continuity between the proximal jejunum and the Roux limb, while a jejunojejunostomy provides distal diversion of pancreaticobiliary secretions. Methods: After a distal hemigastrectomy, 5 dogs underwent the uncut Roux operation, while 5 others had a Billroth II reconstruction (controls). Three weeks later, recordings of jejunal myoelectrical activity and assessment of gastric emptying and bile reflux were performed in fully conscious dogs. Results: In the dogs with uncut Roux limbs, jejunal pacesetter potentials propagated aborally across the neuromuscular bridge, although their frequency was slightly slower distal to the bridge (proximal 19.5 ± 0.7 cpm versus distal 18.8 ± 1.1 cpm; P<0.05). No frequency change occurred across the comparable area of jejunum of the controls. Both groups had similar rates of gastric emptying. Only small amounts of bile acids were found in gastric aspirates from dogs with uncut Roux limbs. Conclusions: A new uncut Roux operation eliminated the Roux stasis syndrome by preserving neuromuscular continuity between the proximal jejunum and the Roux limb, and yet provided near-total diversion of bile from the gastric remnant.

Early clinical results with the uncut roux reconstruction after gastrectomy: Limitations of the stapling technique

The aim of this study was to review our early clinical experience with the uncut Roux gastrectomy, a modified Billroth II gastrojejunostomy in which four rows of staples occlude the afferent jejunal lumen, while biliary and pancreatic secretions are diverted distally through a jejunojejunostomy. Between September 1991 and April 1993, 9 women and 5 men underwent uncut Roux gastrectomy for gastric adenocarcinoma (5), postvagotomy or idiopathic gastroparesis (7), Roux stasis syndrome (1) or anastomotic ulceration with gastric outlet obstruction (1). Subsequently, patients were seen or contacted by phone within the 6 months prior to March 1994. Eight of the 14 patients (57%) had excellent results with stable weight and no nausea, vomiting, heartburn, abdominal pain, or postprandial symptoms. One patient continued to have early satiety and vomiting but maintained stable weight for 19 months postoperatively. Five patients (36%) had poor results with alkaline reflux gastritis or esophagitis. All 5 had documented staple line dehiscence. Four of them were reoperated on and converted to a standard Roux operation with relief of symptoms. The uncut Roux operation prevents the Roux stasis syndrome, but the current technique has an unacceptably high incidence of dehiscence of the staple lines with subsequent reflux gastritis or esophagitis.