REVERSE PHASIC CONTRACTIONS ARE PRESENT IN ANTIPERISTALTIC JEJUNAL LIMBS UP TO 21 YEARS POSTOPERATIVELY

One of the surgical procedures that has been performed to reduce sympt oms of dumping is the antiperistaltic jejunal limb (APL). We hypothesi zed that the polarity of the Phase LII activity fronts would be mainta ined after creation of an APL. To test that hypothesis, water perfused , low compliance intestinal manometry was performed upon four patients with APL, four patients with vagotomy, antrectomy and Roux-en-Y gastr ojejunostomy (VARY) and four volunteers. The patients were studied for a minimum of four hours of fasting. Recordings were analyzed by visua l. inspection by two observers and results are expressed as mean plus or minus standard error of the mean. Statistical analysis was performe d with Student's t test. Phase m activity fronts occurred more frequen tly (1.4+/-0.3 per hour) in the patients with a VARY reconstruction th an in the volunteers (0.5+/-0.5 minute). The duration of Phase II acti vity was significantly less in the patients with the VARY reconstructi on (19.1+/-5.1 minutes) than in the volunteers (49.5+/-5.2 minutes). P atients with reversed activity fronts showed statistically significant propagation velocity (3.0+/-0.6 versus 9.6+/-2.0 centimeters per minu te) (p<0.005), but longer Phase m activity fronts (8.0+/-0.8 versus 4. 9+/-0.3 minutes) (p<0.001) than in the volunteers. Although there were a number of ab normalities identified in the patients with VARY recon struction, there were no reverse Phase III activity fronts seen in the four patients with APL reconstruction. The polarity of the small inte stine is maintained up to 21 years after construction of an antiperist altic jejunal segment.