Experience of stapled Unbalanced Uncut Roux-Y Gastrojejunostomy

ABSTRACT

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.