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

Abstract

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.