THE MODE OF ROUX-EN-Y RECONSTRUCTION AFFECTS MOTILITY IN THE EFFERENTLIMB

Objectives: To compare motility of a Roux-en-Y esophagojejunostomy aft er total gastrectomy with normal-jejunal motility and to determine the effect on motility of the incorporation of a pouch in the reconstruct ion. Design: Jejunal motility in normal subjects was compared with jej unal motility in the Roux-en-Y reconstruction with and without a Hunt- Lawrence pouch. Setting: The cases were collected during a 4-year peri od at a university hospital. The mean time from resection to study was 14 months (range, 4 to 49 months). Patients: Seven control patients w ere compared with 10 patients with a Roux-en-Y reconstruction and 17 w ith a Roux-en-Y and Hunt-Lawrence pouch. Outcome Measure: The fasting- state motility of the jejunum used for reconstruction was measured by a water-perfused manometric system for 2 to 4 hours with the subject i n the supine position. Results: Compared with normal subjects, patient s with a Roux-en-Y esophagojejunostomy without a pouch had an increase d number of phases of the interdigestive motor complex per hour (P<.05 ). The phases were of shorter duration with a random sequence and incr eased total time spent in the quiescent phase 1 (P<.05). In patients w ith a pouch, no differences were detected between the motility in the pouch and the efferent limb. Compared with those without a pouch, ther e were significantly fewer orthograde interdigestive motor complex pha se 3 fronts and more total time spent in phase 1 (P<.05). Conclusions: Construction of a gastric substitute from jejunum leads to substantia l motility changes. The addition of a pouch decreases the overall acti vity, which may contribute to the storage function of the pouch.