Motility in the Roux-Y limb after distal gastrectomy: relation to the length of the limb and the afferent duodenojejunal segment - an experimental study

Following gastrectomy, the longer is a Roux-Y limb constructed to restore d igestive continuity the higher the frequency of postoperative symptoms. The aim of this experimental study was to test how the level of the jejunal tr ansection and the length of the Roux limb affect the motility of the constr ucted limb and in particular the onset and the propagation of activity fron ts (AFs). Three months after a distal Roux-en-Y gastrectomy, electromyographic tracin gs were recorded in six groups of rats grouped according to the level of th e transection (20 or 40 cm from the pylorus) and the length of the limb (10 , 20 or 30 cm). Animals in which a simple laparotomy or laparotomy + jejuna l transection was performed, served as controls. During the interdigestive period, all animals had AFs in the limb which wer e independent from those recorded in the duodenum. In the limb, the mean ti me interval between two AFs was shorter (P < 0.01) and more irregular than in controls. An increase in limb length was associated with a lower inciden ce of completely propagated AFs (P < 0.05) and a higher incidence of irregu larly propagated AFs (P < 0.01). When propagation of the AFs was analysed b oth in the limb and in the jejunum distal to the anastomosis, propagation a bnormalities were more frequent. Below the gastrojejunal anastomosis, for a n intestinal length of either 20 or 30 cm, the frequency of abnormal AFs wa s not different when this length was either only a limb or a limb with the 10 cm of distal jejunum below the jejuno-jejunal anastomosis. Interruption of AFs by a meal was irregular in the limb and more rarely observed in the 30-cm than in 10-cm limbs (P < 0.05). Interruption of AFs was shorter than in controls (P < 0.01). In the duodenum and the jejunum proximal to the lim b, the interval between AFs was higher than in controls and in the Roux-Y l imbs (P < 0.001). Intraluminal concentrations of bacterial strains were not different in the different types of limb while lactobacillus concentration s and pooled concentrations of bacteria were higher than in controls (P < 0 .05). No relationship was found between the incidence of myoelectric abnorm alities and intraluminal bacterial concentrations. Increasing the length of a Roux-Y limb resulted in more frequent disturbanc es in AFs in the limb but had no significant consequence on the overall rat e of abnormal AFs in the jejunum distal to the transection. Motor response to food intake was also reduced. Motor changes were not related to intralum inal bacterial concentrations.