Updates in the research of Roux stasis syndrome / 中华消化外科杂志

Roux-en-Y procedure has widely been used for digestive tract reconstruction after distal or total gastrectomy,and the Roux stasis syndrome is one of the most common complications.The symptoms of Roux stasis syndrome include abdominal pain,abdominal distention,nausea,vomiting and anorexia.Abdominal movement of the intestinal loop and reversed peristalsis cause delayed passage of gastric contents,which is the main cause of the Roux stasis syndrome.Prokinetic agents and electronic stimulation have been investigated as potential nonsurgical treatment methods for Roux stasis syndrome.Uncut Roux-en-Y anastomosis has been found to be effective in preventing Roux stasis syndrome.In the future,precise evaluation of the psychological changes of the digestive tract after the Roux-en-Y anastomosis and understanding the mechanism of Roux stasis syndrome would be more effective to help the surgeons to resolve the problems.

Clinical application of non-mutilation Roux-en-Y digestive tract reconstruction after total gastrectomy / 中国现代普通外科进展

Objective:To investigate the efficacy of three different methods of digestive tract reconstruction after total gastrectomy.Methods:A total of 106 cases underwent the uncutted Roux-en-Y esophagojejunostomy with a jejunal pouch(group A,n=38) ,Roux-en-Y esophagojejunostomy with the J-type jejunal pouch(group B,n=31) ,and Roux-en-Y esophagojejunostomy with the Orr-type jejunal pouch(group C,n=37) respectively.The clinical data were retrospectively studied.The digestive tract reconstruction time,the post-operative complication incidence rate,postprandial symptoms,food-intake quantity,weight,serum nutritional parameters and emptying time of the gastricsubstitute were compared respectively.Results:The reconstruction time was the shortest in group A,which was significantly shorter than that in group B(P0.05) ,Group A was significantly lower than group B and C in the incidence of roux stasis syndrome.The Visick score of group A were superior to those of group B and C in 6 and 12 months after operation.The food intake gain of group A and B were superior to that of group C 6 and 12 months after operation.There were no significant differences among 3 groups in the term of weight,Hb and ALB loss and prognosis nutritional index(PNI) 6 months postoperatively.Weight and ALB loss in group A and B were lower than those in group C 12 months postoperatively,but PNI was higher in group A and B than those in group C.Emptying time of the gastric substitute was prolonged both in group A and B 12 months postoperatively.Conclusion:The uncutted Roux-en-Y esophagojejunostomy may act as an adoptable method of digestive tract reconstruction after total gastrectomy for gastric cancer.

The effects of Roux-en-Y limb length on gastric emptying and enterogastric reflux in rats

PURPOSE: To assess the effects of Roux-en-Y jejunal limb length on gastric emptying and enterogastric reflux. METHODS: Seventy male Wistar rats were submitted to antrectomy with Roux-en-Y reconstruction and then were divided into two groups of 35 animals. Group A, short limb (7.5 cm) and Group B, standard limb (15 cm). Group A and B were subdivided into five subgroups each in order to study enterogastric reflux at 30 and 60 minutes and to evaluate gastric emptying at 5, 10 and 15 minutes. In order to measure gastric emptying and enterogastric reflux, radiotracers 99m Tc-Phytate and 99m Tc-DISIDA were respectively used. RESULTS: For gastric emptying, the radiotracer concentration was lower in Group A than in Group B after five minutes. The enterogastric reflux was present, but there were no significant differences between enterogastric reflux indexes concerning both A and B Groups. CONCLUSION: A standard Roux limb, besides being unable to protect the stomach from the enterogastric reflux, may become a functional barrier for gastric emptying.

OBJETIVO: Determinar os efeitos do comprimento da alça jejunal em Y de Roux sobre o esvaziamento gástrico e o refluxo enterogástrico. MÉTODOS: Setenta e cinco ratos machos foram submetidos à antrectomia com reconstrução em Y de Roux e divididos em dois grupos de 35 animais. Grupo A, alça curta (7,5cm) e Grupo B (15cm), alça de comprimento padrão. Os grupos A e B foram subdivididos em cinco subgrupos cada para o estudo do refluxo enterogástrico aos 30 e 60 minutos e para o estudo do esvaziamento gástrico aos 5, 10 e 15 minutos. 99m Tc-Fitato and 99m Tc-DISIDA foram utilizados para os estudos do esvaziamento gástrico e do refluxo enterogástrico, respectivamente. RESULTADOS: No estudo do esvaziamento gástrico, a concentração do radiotraçador foi menor no grupo A do que no Grupo B aos cinco minutos. Foi encontrado o refluxo enterogástrico, nos grupos A e B, sem diferenças entre eles. CONCLUSÃO: A alça em Y de Roux de comprimento padrão foi ineficaz em proteger o estômago do refluxo enterogástrico, e pode tornar-se uma barreira funcional ao esvaziamento gástrico.

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. MATENRIALS 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 7~12, 13~18, 19~24, 25~30, and 31~36 months. RESULTS: According to the criteria, the Roux stasis syndrome occurred in 40.0% of the patients at 7~12 months, 33.3% at 13~18 months, 35.3% at 19~24 months, 32.0% at 25~30 months, and 33.3% at 31~36 months after a conventional Roux-en-Y operation. The syndrome occurred in 22.6% of the patients at 7~12 months, 15.2% at 13~18 months, 17.1% at 19~24 months, 19.2% at 25~30 months, and 20% at 31~36 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.

A Clinical Study of the Uncut Roux-en-Y Gastrojejunostomy Using a Short Roux Limb after Subtotal Gastrectomy

PURPOSE: The restoration of intestinal continuity following subtotal gastrectomy for gastric malignancy as well as benign gastric disease is an important area for research. The aim of this study was to compare the uncut Roux-en-Y reconstruction using a short Roux limb (20 to 30 cm) with the uncut Roux-en-Y reconstruction using a long Roux limb (more than 40 cm). METHODS: 48 patients (33 men and 15 women) underwent uncut Roux-en-Y reconstruction using a short Roux limb (short Roux limb group), and 32 patients (19 men and 13 women) had the Roux-en-Y operation using a long Roux limb (long Roux limb group). We assessed the outcome of these operations on the occurrence of Roux stasis syndrome, the endoscopic findings, and the required period for the nasogastric tube. RESULTS: Roux stasis syndrome occurred in 9 patients (18.8%) in the short Roux limb group, and in 10 patients (31.3%) in the long Roux limb group (p value 0.201). Pathological endoscopic finding were observed in 5 patients (10.4%) in the short Roux limb group, and in 6 patients (18.8%) in the long Roux limb group (p=0.292). CONCLUSION: Comparing the short Roux limb group with the long Roux limb group in uncut Roux-en-Y reconstruction after subtotal gastrectomy, We can conclude that uncut Roux-en-Yreconstruction using a short Roux limb is an effective reconstruction procedure to alleviate Roux stasis syndrome, reflux gastritis and esophagitis.

Uncut Roux Procedure after Total Gastrectomy

The Roux-en-Y esophagojejunostomy is one of the most common means of reconstructive surgery after a total gastrectomy. While these Roux operations work well in the majority of patients, approximately 30% of individuals undergoing them develop the so-called Roux stasis syndrome, consisting of chronic abdominal pain, nausea, vomiting, and postprandial bloating. The Roux stasis syndrome is thought to result from the jejunal transsection performed during the construction of a conventional Roux limb. The aim of this study was to review a new type of uncut Roux procedure, in which staple lines and loop ligation maintain myoneural continuity and prevent the Roux stasis syndrome between the proximal jejunum and the Roux limb. At the same time, a jejunojejunostomy provides distal diversion of pancreaticobiliary secretions. The postoperative courses of 23 cases of the uncut Roux procedure with staples after a total gastrectomy were compared with those of 18 cases of afferent proximal loop ligation with hand-sewn sutures, the procedures having been performed between May 1995 and January 1997. Passage of contrast media through the ligated afferent jejunal loop was identified in 34.8% of cases and occluded staple lines was identified in 38.9% of cases. It was found that the uncut Roux procedure prevents the Roux stasis syndrome and that the current technique has a high incidence of dehiscence of the staple lines and the loop ligation with subsequent reflux esophagitis. Because of the results reported here, other techniques, which maintain enteric myoneural continuity to an uncut Roux limb while providing complete and permanent diversion of the alkaline secretions distally from the esophagus, need to be developed before this type of anatomic reconstruction can be recommended.

Experience of stapled Unbalanced Uncut Roux-Y Gastrojejunostomy

Roux-en-Y reconstruction is an occasional occurrence of Roux-Y stasis syndrome, characterized by chronic abdominal pain, persistent nausea, and intermittent vomiting. Construction of the Roux limb requires transection of the jejunum, which disturbs normal propagation of pacesetter potential and evokes development of ectopic pacemakers in the Roux limb. Ectopic pacemakers in the Roux limb generate pacesetter potentials, which with their associated orally propagating contractions, result in slower transit through the Roux limb.To prevent the Roux stasis syndrome, a new operation has been designed that is similar to the standard Roux-en-Y gastrojejunostomy construction but theoretically without inherent motor pathophysiology. The authors designed a new unbalanced " Uncut Roux-en-Y" procedure to avoid postoperative blind loop syndrome and performed the procedures with staple occlusion of the afferent loop in 11 patients who required gastric resection and reconstruction, during a period of 6 months from April 1995 to September 1995. Results were summarized as follows. 1) 9 of the 11 patients( 81%) had excellent results with stable or increased weight and no stasis syndrome. 2) 2 patients(19%) had poor results with alkaline reflux gastritis or esophagitis. Both had documented staple line dehiscence. One of them was operated on and converted to a standard Roux operation, but died. The other one continued to loose weight but maintained a normal dietary pattern. 3) Unbalanced Roux technique worked well without harmful complications. 4) Reinforcing serosal sutures on the staple line could prevent a possible jejunal leakage in the case of staple line dehiscence and might prevent dehiscence of staple lines.