Roux-en-Y limb motility after total or distal gastrectomy in symptomatic and asymptomatic patients

Background: The aims of this study were to compare Roux-en-Y limb motor pat terns after total or distal gastrectomy, and to identify possible motor dif ferences between symptomatic and asymptomatic patients. The usefulness of p reoperative recording was also investigated, Study Design: Sixteen patients were enrolled in the study, 10 patients afte r total gastrectomy (TG group) and 6 patients after distal gastrectomy (DG group). In 6 of 10 patients in the TG group, recordings were obtained befor e and after operation. Manometric recordings in the limb lasted 6 hours in all patients, 3 hours during fasting, and 3 hours after a 750-kcal meal. An intravenous injection of trimebutine (100-mg IV) was systematically admini stered at the end of each recording session. Motor results of the patients were compared with those obtained in the intact jejunum of 20 healthy contr ols. Results: After operation, when patients were compared with controls, phase III (ie, regular activity of the migrating motor complex) was more frequent and more often incompletely propagated (5 of 16 patients versus 1 of 20 co ntrols, unadjusted p < 0.05) and was significantly slower (p < 0.01 versus controls). Intravenous trimebutine induced phase III in 12 of 16 patients w ithin a mean of 8.8 +/- 1 (SEM) minutes, longer than in controls (delay < 2 minutes). The fed pattern was shorter than in controls in both TG and DG g roups, and the postprandial area under the curve during successive 30-minut e periods was reduced in the DG group compared with controls (p < 0.01). In patients investigated before gastrectomy, motor parameters were not differ ent from those of controls. Surgery re-suited in an increased number of pha se IIIs and a decreased migration velocity (p < 0.01) of phase III, a longe r delay in response after trimebutine (p < 0.0001), and a reduced postprand ial motor response (p < 0.01). After the operation, 4 of 10 patients in the TG group and 5 of 6 patients in the DG group were symptomatic. Symptomatic patients had slower and more often incompletely propagated (p < 0.01) phas e III compared with asymptomatic patients. Conclusions: Roux-en-Y limb reconstruction mainly disturbs phase III propag ation and the motor response to a meal. Motor changes are more marked after DG than after TG. Disturbed phase III propagation is the main difference b etween symptomatic and asymptomatic patients. Successful induction of phase III with trimebutine after gastrectomy and Roux-en-Y reconstruction indica tes maintenance of encephalinergic mechanisms. (J Am Coll Surg 2000;190:408 -417. (C) 2000 by the American College of Surgeons).