The Roux stasis syndrome. Treatment by pacing and prevention by use of an 'uncut' Roux limb

Abstract

Ectopic pacemakers in the Roux limb are associated with delayed gastric emptying after Roux gastrectomy. The aim herein was to suppress the ectopic pacemakers by electrical pacing or to prevent them by maintaining enteric myoneural continuity with an "uncut" Roux limb, and so improve the delayed emptying. Among eight dogs with truncal vagotomy and Roux hemigastrectomy, four dogs had a pacing electrode applied to the proximal end of the Roux limb. The other four dogs had a gastrojejunostomy to an uncut Roux limb. In them, the afferent jejunal limb was occluded by staples but not divided, and a diverting jejuno-jejunostomy was performed. Roux pacing and the uncut Roux operation abolished ectopic pacemakers in the Roux limb and speeded the slow gastric emptying present in unpaced control tests. At autopsy, however, dehiscences were found in the staple line in the dogs with the uncut Roux procedures. In conclusion, electrical pacing and the uncut Roux limb show promise as techniques to prevent ectopic jejunal pacemakers and gastric stasis after Roux gastrectomy. Both must be improved before they can be used in patients.