Alteration of the Roux stasis syndrome by an isolated Roux limb: Correlation of slow waves and clinical course

The Roux-Y stasis syndrome after antrectomy and vagotomy has been well desc ribed. Delayed gastric emptying after vagotomy and antrectomy with Roux-Y a nastomosis has been attributed to loss of the duodenal pacemaker and to the effects of retrograde slow-wave activity arising from distal small bowel p acemakers. Small bowel contractions are closely coupled with slow-wave acti vity. Transection and anastomosis of the small bowel distal to the jejuno-j ejunostomy has been shown to electrically isolate the Rowe limb from distal small bowel pacemakers. Using a canine model, a vagotomy and hemigastrecto my with Roux-Y were performed in five dogs using the standard operation (co ntrol); in four dogs (experimental), an additional transection and reanasto mosis of the jejunum 25 cm distal to the Y anastomosis of the Roux limb was performed. All specimens had six electrodes implanted along the Roux limb at 5-cm intervals, used for weekly analysis of the jejunal slow-wave activi ty. The isolated loop cohort had reduced incidence of retrograde slow waves , reduced emesis, improved gastric emptying by upper gastrointestinal serie s, and reduced gastric pouch size at autopsy. Adding a distal transection a nd anastomosis, thus creating an isolated Roux-Y segment, may improve the c ourse of the Roux stasis syndrome.