ELIMINATION OF THE ROUX STASIS SYNDROME USING A NEW-TYPE OF UNCUT ROUX LIMB

BACKGROUND: The Roux stasis syndrome, a syndrome of nausea, vomiting, abdominal pain, and postprandial fullness that follows Roux-en-Y gastr ojejunostomy, is thought to result from the jejunal transection perfor med during the construction of a conventional Roux limb. The purpose o f this study was to test a new type of ''uncut'' Roux limb constructio n, in which a neuromuscular bridge maintains neuromuscular continuity between the proximal jejunum and the Roux limb, while a jejunojejunost omy provides distal diversion of pancreaticobiliary secretions. METHOD S: After a distal hemigastrectomy, 5 dogs underwent the uncut Roux ope ration, white 5 others had a Billroth II reconstruction (controls), Th ree weeks later recordings of jejunal myoelectrical activity and asses sment of gastric emptying and bile reflux were performed in fully cons cious dogs. RESULTS: In the dogs with uncut Roux limbs, jejunal pacese tter potentials propagated aborally across the neuromuscular bridge, a lthough their frequency was slightly stower distal to the bridge (prox imal 19.5 +/- 0.7 cpm versus distal 18.8 +/- 1.1 cpm; P <0.05), No fre quency change occurred across the comparable area of jejunum of the co ntrols. Both groups had similar rates of gastric emptying, Only small amounts of bile acids were found in gastric aspirates from dogs with u ncut Roux limbs. CONCLUSIONS: A new uncut Roux operation eliminated th e Roux stasis syndrome by preserving neuromuscular continuity between the proximal jejunum and the Roux limb, and yet provided near-total di version of bile from the gastric remnant.