Roux-en-Y Limb Motility after Total Gastrectomy
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The Roux-en-Y stasis syndrome is a troublesome postgastrectomy syndrome. Although the era of gastric resection for peptic ulcer disease has almost come to an end, the increasing incidence of proximal gastric cancer and the outbreak of bariatric operations make the study of the motility of the Roux-en-Y limb (RYL) after gastric resection or gastroplasty very relevant.This study aims to evaluate the motility of the RYL after total gastrectomy using high-resolution manometry (HRM). We performed an HRM on 8 patients after total gastrectomy for proximal gastric cancer and Roux-en-Y reconstruction, 74 ± 111 months after the operation. At the time of the study, all patients were asymptomatic without evidence of cancer recurrence.Peristaltic waves were noticed at the RYL in 3 (37 %) of the patients. The mean wave amplitude of the peristaltic waves was 63 ± 29 (37–94) mmHg and 83 ± 35 (42–104) mmHg at 3 and 7 cm below the esophagojejunal junction, respectively. Simultaneous waves were noticed in 6 (75 %) of the patients in 80 ± 32 % (30–100) of the swallows of these patients. No patient presented with absence of motor activity detectable at the HRM. Our results show that: (1) esophageal motility is normal after total gastrectomy with Roux-en-Y reconstruction; (2) motor activity is always detectable at the proximal RYL, but peristalsis is abnormal in most patients; and (3) absence of peristalsis does not translate into symptoms.
KeywordsTotal gastrectomy Roux-en-Y esophagojejunostomy Roux-en-Y syndrome Post-gastrectomy syndromes Small bowel manometry High-resolution manometry
We are indebted to Ms. Mirian Wolfarth and Ms. Priscila M.A. Capuzzo for their invaluable assistance with the tests.
- 1.Gustavsson S, Ilstrup DM, Morrison P, Kelly KA. Roux-Y stasis syndrome after gastrectomy. Am J Surg. 1988 Mar;155(3):490–4.Google Scholar
- 2.Zittel TT, Jehle EC, Becker HD. Surgical management of peptic ulcer disease today—indication, technique and outcome. Langenbecks Arch Surg. 2000 Mar;385(2):84–96.Google Scholar
- 4.Noh SM. Improvement of the Roux limb function using a new type of “uncut Roux” limb. Am J Surg. 2000 Jul;180(1):37–40.Google Scholar
- 5.Carlson DA, Pandolfino JE. High-resolution manometry and esophageal pressure topography: filling the gaps of convention manometry. Gastroenterol Clin North Am. 2013 Mar;42(1):1–15.Google Scholar
- 6.Vicentine FP, Herbella FA, Allaix ME, Silva LC, Patti MG. Comparison of idiopathic achalasia and Chagas’ disease esophagopathy at the light of high-resolution manometry. Dis Esophagus. 2013 Jun 24. doi: 10.1111/dote.12098.
- 7.Herbella FA, Tineli AC, Wilson JL Jr, Del Grande JC. Gastrectomy and lymphadenectomy for gastric cancer: is the pancreas safe? J Gastrointest Surg. 2008 Nov;12(11):1912–4. doi: 10.1007/s11605-008-0572-1. Epub 2008 Jul 9.
- 8.Marinari GM, Murelli F, Camerini G, Papadia F, Carlini F, Stabilini C, Adami GF, Scopinaro N. A 15-year evaluation of biliopancreatic diversion according to the bariatric analysis reporting outcome system (BAROS). Obes Surg. 2004 Mar;14(3):325–8.Google Scholar
- 9.Laurino Neto RM, Herbella FA, Tauil RM, Silva FS, de Lima SE Jr. Comorbidities remission after Roux-en-Y Gastric Bypass for morbid obesity is sustained in a long-term follow-up and correlates with weight regain. Obes Surg. 2012 Oct;22(10):1580–5.Google Scholar
- 10.Wolfier A. Aur technik der gastro-enterostomie und ahnlicher operationen mit demonstration von praparaten. Deutsch Ges Chir Verhandl. 1883;12:21.Google Scholar
- 11.Roux C. De la gastroenterostomie. Rev Gynec Chir Abd. 1897;1:67.Google Scholar
- 14.Van der Mijle HC, Kleibeuker JH, Limburg AJ, Beekhuis H, Lamers CB, van Schilfgaarde R. Role of vagal dysfunction in motility and transit disorders of jejunal Roux limb after Roux-en-Y gastrojejunostomy. Dig Dis Sci. 1994 Apr;39(4):827–33.Google Scholar
- 15.Hirao M, Fujitani K, Tsujinaka T. Delayed gastric emptying after distal gastrectomy for gastric cancer. Hepatogastroenterology. 2005 Jan–Feb;52(61):305–9.Google Scholar
- 16.Masui T, Kubora T, Nakanishi Y, Aoki K, Sugimoto S, Takamura M, Takeda H, Hashimoto K, Tokuka A. The flow angle beneath the gastrojejunostomy predicts delayed gastric emptying in Roux-en-Y reconstruction after distal gastrectomy. Gastric Cancer. 2012 Jul;15(3):281–6. doi: 10.1007/s10120-011-0107-4. Epub 2011 Nov 2.
- 17.Bolton JS, Conway WC 2nd. Postgastrectomy syndromes. Surg Clin North Am. 2011 Oct;91(5):1105–22.Google Scholar
- 18.Cozzaglio L, Coladonato M, Dagrada CT, Doci R, Gennari L. Does the Roux-en-Y-stasis syndrome still exist? Chir Ital. 2005 Jan–Feb;57(1):27–34.Google Scholar
- 20.Pellegrini CA, Deveney CW, Patti MG, Lewin M, Way LW. Intestinal transit of food after total gastrectomy and Roux-Y esophagojejunostomy. Am J Surg. 1986 Jan;151(1):117–25.Google Scholar
- 21.Husebye E. The patterns of small bowel motility: physiology and implications in organic disease and functional disorders. Neurogastroenterol Motil. 1999 Jun;11(3):141–61.Google Scholar
- 22.Dinning PG, Arkwright JW, Costa M, Wiklendt L, Hennig G, Brookes SJ, Spencer NJ. Temporal relationships between wall motion, intraluminal pressure, and flow in the isolated rabbit small intestine. Am J Physiol Gastrointest Liver Physiol. 2011 Apr;300(4):G577–85. doi: 10.1152/ajpgi.00532.2010. Epub 2010 Dec 30.
- 23.Mathias JR, Khanna R, Nealon WH, Browne RM, Reeves-Darby VG, Clench MH. Roux-limb motility after total gastrectomy and Roux-en-Y anastomosis in patients with Zollinger–Ellison syndrome. Dig Dis Sci. 1992 Apr;37(4):545–50.Google Scholar
- 24.Thomas H, Heimbucher J, Fuchs KH, Freys SM, DeMeester TR, Peters JH, Bremner CG, Thiede A. The mode of Roux-en-Y reconstruction affects motility in the efferent limb. Arch Surg. 1996 Jan;131(1):63–6.Google Scholar
- 25.Mathias JR, Fernandez A, Sninsky CA, Clench MH, Davis RH. Nausea, vomiting, and abdominal pain after Roux-en-Y anastomosis: motility of the jejunal limb. Gastroenterology. 1985 Jan;88(1 Pt 1):101–7.Google Scholar
- 26.Haglund U, Fork FT, Högström H, Lilja B. Esophageal and jejunal motor function after total gastrectomy and Roux-Y esophagojejunostomy. Am J Surg. 1989 Mar;157(3):308–11.Google Scholar