Manometric and scintigraphic studies of the relation between motility disturbances in the roux limb and the Roux-en-Y syndrome

Mijle, Huub C J van der; Kleibeuker, Jan H.; Limburg, A. J.; Bleichrodt, R. P.; Beekhuis, H; Schilfgaarde, R. van

doi:10.1016/s0002-9610(05)80574-4

Cited by 66 publications

(33 citation statements)

References 20 publications

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“…There have been many causes proposed for the development of Roux stasis, including functional obstruction of the Roux limb, an ectopic pacemaker arising in the Roux limb that drives contractions in a reverse direction toward the stomach [11,12], and gastroparesis after vagotomy [13]. On the basis of these hypotheses, uncut Roux Y reconstruction [14] or rho-shaped Roux Y reconstruction have been proposed and found to be effective in avoiding Roux stasis [15,16].…”

Section: Introductionmentioning

confidence: 99%

The flow angle beneath the gastrojejunostomy predicts delayed gastric emptying in Roux-en-Y reconstruction after distal gastrectomy

et al. 2011

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Background Delayed gastric emptying without mechanical obstruction after Roux-en-Y reconstruction has been defined as Roux stasis syndrome. It occurs in 10-30% of patients after such reconstruction. So far, the cause of this stasis has not been completely identified. This study aimed to reduce Roux stasis using surgical techniques. Methods From November 2007 to October 2010, we performed 101 distal gastrectomies with Roux-en-Y reconstruction. All the gastrojejunostomies were performed with end-to-end anastomoses. Roux stasis was analyzed with respect to tumor location, extent of the dissection, tumor progression, operation time, antecolic/retrocolic reconstruction, and the shape of the gastrojejunostomy. The shape of the gastrojejunostomy was evaluated by contrast gastroradiography 4 days after the operation. Results Roux stasis syndrome was observed in 17 of the 101 patients. There was no relationship between the extent of the dissection, tumor progression, or operation time and the occurrence of Roux stasis. There was no difference in the incidence of Roux stasis between antecolic and retrocolic reconstructions. However, the group that displayed a straight anastomotic shape on contrast radiography demonstrated an apparently lower incidence of Roux stasis (p = 0.0003). In addition, Roux-en-Y reconstruction following gastric cancer was more frequently followed by Roux stasis in the antrum than in the midstomach (p = 0.0036). Cases of Roux stasis occurred 11.8 days after surgery on average and resolved within 2 weeks on average. Conclusions Our findings demonstrate the substantial benefits of a straight anastomosis of the gastrojejunostomy for the prevention of Roux stasis syndrome.

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Section: Introductionmentioning

confidence: 99%

The flow angle beneath the gastrojejunostomy predicts delayed gastric emptying in Roux-en-Y reconstruction after distal gastrectomy

et al. 2011

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“…It also seemed logical to use the same technique in revisional gastric operations for mechanical postgastrectomy complications. Of all the patients in this series who had a Roux-en-Y gastrojejunostomy to prevent bile reflux gastritis (12), none had bilious vomiting, bile reflux gastritis, or both.…”

Section: Resultsmentioning

confidence: 83%

Long-Term Follow-up of Patients with Roux-en-Y Gastrojejunostomy for Gastric Disease

et al. 1994

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ObjectiveA consecutive series of Roux-en-Y gastrojejunostomies with a mean follow-up of 11.9 years was reviewed to characterize the long-term results of patients having this operation to treat or prevent bile reflux gastritis. Summary BackgroundDevelopment of postprandial abdominal discomfort, nausea, vomiting, or bezoar formation (Roux stasis syndrome) in the postoperative follow-up period has prompted questions about the role of Roux-en-Y gastrojejunostomy to treat or prevent bile reflux gastritis. MethodsLong-term clinical follow-up (mean, 11.9 years) data for 24 patients was collected by reviewing medical records, interviewing patients directly through telephone contact, or both. All patients who had symptoms in the follow-up period were evaluated by upper gastrointestinal series, endoscopy, or both. A modified Visick scale was used for clinical ratings.

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“…The major disadvantages of the RY reconstruction are possible motor irregularities linked to both propagation disturbances of the migrating motor complex (especially in a retrograde direction) [21], and to decreased postprandial activity of the Roux limb [22]. Moreover, the reduced postprandial motor response suggests a hormonal mediator abnormality [23].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Fat Digestive and Absorptive Function after Subtotal Gastrectomy by a <sup>13</sup>C-Labeled Mixed Triglyceride Breath Test

Nakamura

Murakami²,

Morifuji³

et al. 2009

Digestion

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Background/Aim: In the choice of reconstructions, digestive and absorptive disturbances, resulting in weight loss after subtotal gastrectomy, remain a problem. The aim of this study was to compare fat absorptive function after Billroth I (B-I) and Roux-en-Y (RY) reconstructions after subtotal gastrectomy for gastric cancer. Methods: A ¹³C-labeled mixed triglyceride breath test was performed in 31 patients after subtotal gastrectomy and in 15 healthy volunteers to assess fat digestive and absorptive function. Seventeen B-I reconstructions and 14 RY reconstructions were performed after subtotal gastrectomy. Fat digestive and absorptive function was determined by percent ¹³CO₂ cumulative dose at 7 h. Relationship between fat absorptive function and perioperative factors were analyzed. Results: Gender distribution, mean age, pathological staging, level of lymph node dissection, preservative procedure of the vagus nerve and mean follow-up period in the two surgical groups did not differ significantly. Only the type of reconstruction (p = 0.024) was associated with differences in fat digestive and absorptive function by univariate analysis: B-I reconstruction was superior to RY reconstruction. Conclusions: Fat digestive and absorptive function after B-I reconstruction was superior to that after RY reconstruction, probably because the B-I reconstruction was the procedure that permitted food passage through the duodenum.

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Manometric and scintigraphic studies of the relation between motility disturbances in the roux limb and the Roux-en-Y syndrome

Cited by 66 publications

References 20 publications

The flow angle beneath the gastrojejunostomy predicts delayed gastric emptying in Roux-en-Y reconstruction after distal gastrectomy

The flow angle beneath the gastrojejunostomy predicts delayed gastric emptying in Roux-en-Y reconstruction after distal gastrectomy

Long-Term Follow-up of Patients with Roux-en-Y Gastrojejunostomy for Gastric Disease

Analysis of Fat Digestive and Absorptive Function after Subtotal Gastrectomy by a <sup>13</sup>C-Labeled Mixed Triglyceride Breath Test

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