Motility Disorders after Roux-en-Y Gastrojejunostomy |
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Authors: | BaoLien Nguyen Tu MD Keith A Kelly MD |
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Institution: | (1) Department of Surgery, Mayo Clinic, Scottsdale, AZ 85259, USA;(2) Department of Surgery, Mayo Clinic, Scottsdale, AZ 85259, USA |
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Abstract: | About 30% of patients who have a Roux-en-Y gastrojejunostomy after gastrectomy suffer from abdominal pain, nausea, vomiting
of food and bloating made worse by eating. This syndrome, called the Roux stasis syndrome, is caused, in part, by a motility
disorder of the Roux limb. Transection of the jejunum during the construction of the limb separates the limb from the natural
small intestinal pacemaker located in the duodenum. Ectopic pacemakers then appear in the limb and trigger retrograde contractions
in its proximal portion. These contractions slow transit through the limb and result in Roux stasis. Current nonsurgical treatment
of the syndrome includes the use of prokinetic agents and intestinal pacing, neither of which has demonstrated long-term benefits.
A near-total gastrectomy may speed upper gastrointestinal transit somewhat, but stasis in the Roux limb often persists. Our
current approach aims at preventing the syndrome by the use of an ‘uncut’ Roux limb, an operation which preserves myoneural
continuity between the duodenal pacemaker and the Roux limb and so prevents the appearance of ectopic pacemakers and stasis
in the limb. |
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Keywords: | Roux-en-Y anastomosi Roux limb motilit ectopic pacemaker prokinetic agent intestinal pacin uncut Roux operatio neuromuscular bridge |
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