In vitro motility changes in Roux limb after Roux-en-Y reconstructio

Abstract

Abstract:Background: The aim of this study is to compare the motility of Roux limb with that of normal segment. Materials and methods: Rats were divided into 3 equal groups as control, Roux-en-Y (Group A) and Roux-en-Y with vagotomy (Group B). Only midline incision and manipulations were applied in control group. Following distal gastrectomy, Roux-en-Y reconstruction was applied in Group A, while vagotomy Roux-en-Y gastrojejunostomy was applied in Group B. Rats were sacrifi ced 1 month later by cervical dislocations under anesthesia. The obtained jejunal segments were cut into four equal parts. The bath was 37 °C warm while 95 % O2 and 5 % CO2 gases were supplied in 10 ml bicarbonate Krebs' solution. Results: KCl responses were similar in all three groups. Acetylcholine contraction responses in the vagotomy and non-vagotomy Roux-en-Y groups was higher than in those in control group signifi cantly (p < 0.05). This response in vagotomy Roux-en-Y group was also higher than that in non-vagotomy group (p < 0.05). The induced electrical fi eld stimulation contraction response in the vagotomy + Roux-en-Y group was lower than those in control group and non-vagotomy group (p < 0.05). Conclusions: These results show that muscarinic receptor density and/or function may increase after vagotomy and non-vagotomy group operation, and vagotomy may contribute to this increase. The decrease in electrical signal response in vagotomy Roux-en-Y group may depend on the decrease in acetylcholine oscillation from the cholinergic nerve ending (Tab. 1, Fig. 5, Ref. 25). Text in PDF www.elis.sk.

Overlap Anastomosis for Digestive Reconstruction during Laparoscopic Distal Gastrectomy with Intensive Regional Lymph Node Dissection: Physiological Impact of Preserving the Mesenteric Autonomic Nerves in the Lifted Jejunal Limb

“…Roux-en-Y stasis syndrome has been reported [ 29 , 30 ], as well as the disadvantages of vagotomy in Roux-en-Y reconstruction [ 10 , 11 ] because vagal nerves around the esophagus are usually transected in total gastrectomy. However, vagal nerves around the esophagus are preserved during distal gastrectomy; therefore, we focused on the benefits of a sacrificed jejunum when creating the lifted jejunal limb [ 12 , 13 ].…”

“…Although linear-stapled anastomosis for Billroth I (“delta anastomosis”) is suitable for laparoscopic distal gastrectomy [ 5 ], Billroth II or Roux-en-Y is required in patients with smaller gastric remnant or shorter duodenal stump. Although the disadvantages of vagotomy for Roux-en-Y reconstruction in total gastrectomy have been documented [ 10 , 11 ], vagal nerves around the esophagus (Latarjet's nerves) are preserved during distal gastrectomy.…”