MOTILITY DISORDERS AFTER ROUX-EN-Y GASTROJEJUNOSTOMY

About 30% of patients who have a Roux-en-Y gastrojejunostomy after gas trectomy suffer from abdominal pain, nausea, vomiting of food and bloa ting made worse by eating. This syndrome, called the Roux stasis syndr ome, is caused, in part, by a motility disorder of the Roux limb. Tran section of the jejunum during the construction of the limb separates t he limb from the natural small intestinal pacemaker located in the duo denum. Ectopic pacemakers then appear in the limb and trigger retrogra de contractions in its proximal portion. These contractions slow trans it through the limb and result in Roux stasis. Current nonsurgical tre atment of the syndrome includes the use of prokinetic agents and intes tinal pacing, neither of which has demonstrated long-term benefits. A near-total gastrectomy may speed upper gastrointestinal transit somewh at, but stasis in the Roux limb often persists. Our current approach a ims at preventing the syndrome by the use of an 'uncut' Roux limb, an operation which preserves myoneural continuity between the duodenal pa cemaker and the Roux limb and so prevents the appearance of ectopic pa cemakers and stasis in the limb.