Abstract
Purpose
Uncut Roux-en-y is a reconstruction method with a main purpose of diminishing Roux stasis syndrome. In this study we performed this procedure to evaluate utility and complications of this technique, as well as its effect on Roux stasis syndrome.
Methods
Total gastrectomy with Uncut Roux-en-y esophagojejunostomy was performed on 94 patients. This technique consists of an artificial jejunal occlusion 5 cm proximal to anastomosis and a jejunojejunostomy between afferent and efferent loops. Diagnosis of “Roux stasis syndrome” was made by clinical criteria.
Results
According to the mentioned criteria, the “Roux stasis syndrome” occurred in 21.2% of the patients. Whereas occurrence rate of other complications was: dysphasia (13.8%), benign stricture in anastomosis (9.6%), and fistula (5.3%).
Conclusions
Comparing the results of our study to other related studies indicates that this type of operation has lower rate of “Roux stasis syndrome”, and also decreases the postoperative stricture rate of the anastomosis.
Keywords: Roux-en-y esophagojejunostomy, Uncut Roux-en-y esophagojejunostomy, Total gastrectomy, Roux stasis syndrome
Full Text
The Full Text of this article is available as a PDF (158.0 KB).
References
- 1.Barbarisi A., Parisi V., Parmeggiani U., Cremona F., Delrio P. Impact of surgical treatment on quality of life of patients with gastrointestinal tumors. Ann Oncol. 2001;12:27–30. doi: 10.1023/A:1013086713645. [DOI] [PubMed] [Google Scholar]
- 2.Takeshita K., Sekita Y., Tani M. Medium — and longterm results of jejunal pouch reconstruction after a total and proximal gastrectomy. Surg Today. 2007;37:754–761. doi: 10.1007/s00595-007-3497-5. [DOI] [PubMed] [Google Scholar]
- 3.Espat N.J., Karpeh M. Reconstruction following total gastrectomy: a review and summary of the randomiezed prospective clinical trials. Surg Oncol. 1998;7:65–69. doi: 10.1016/S0960-7404(98)00027-9. [DOI] [PubMed] [Google Scholar]
- 4.Paolini A., Tosato F., Cassese M., Marchi C., Grande M., Paoletti P., et al. Total gastrectomy in the treatment of adenocarcinoma of the cardia. Review of the results in 73 resected patients. Am J Surg. 1986;151:238–243. doi: 10.1016/0002-9610(86)90077-2. [DOI] [PubMed] [Google Scholar]
- 5.Butler J.A., Dubrow T.J., Trezona T., Klassen M., Nejdl R.J. Total gastrectomy in the treatment of advanced gastric cancer. Am J Surg. 1989;158:602–604. doi: 10.1016/0002-9610(89)90203-1. [DOI] [PubMed] [Google Scholar]
- 6.Gustavsson S., Kelly K.A. Total gastrectomy for benign disease. Surg Clin North Am. 1987;67:539–550. doi: 10.1016/s0039-6109(16)44231-3. [DOI] [PubMed] [Google Scholar]
- 7.Gustavsson S., Ilstrup D.M., Morrison P., Kelly K.A. Roux-en-ystasis syndrome after gastrectomy. Am J Surg. 1988;155:490–494. doi: 10.1016/S0002-9610(88)80120-X. [DOI] [PubMed] [Google Scholar]
- 8.Noh S.M. Improvement of the roux limb function using a new type of “Uncut Roux Limb”. Am J Surg. 2000;180:37–40. doi: 10.1016/S0002-9610(00)00421-9. [DOI] [PubMed] [Google Scholar]
- 9.Mathias J.R., Fernandez A., Sninsky C.A., Clench M.H., Davis R.H. Nausea, vomiting and abdominal pain after Roux-en-y anastomosis: motility of the jejunal limb. Gastroenterology. 1985;88:101–107. doi: 10.1016/s0016-5085(85)80140-2. [DOI] [PubMed] [Google Scholar]
- 10.Morrison P., Miedema B.W., Kohler L., Kelly K.A. Electrical dysrhythmias in the Roux jejunal limb: cause and treatment. Am J Surg. 1990;160:252–256. doi: 10.1016/S0002-9610(06)80017-6. [DOI] [PubMed] [Google Scholar]
- 11.Miedema B.W., Kelly K.A. The Roux stasis syndrome. Treatment by pacing and prevention by use of an “uncut” Roux limb. Arch Surg. 1992;127:295–300. doi: 10.1001/archsurg.1992.01420030057011. [DOI] [PubMed] [Google Scholar]
- 12.Kiciak A., Woliñski J., Borycka K., Zabielski R., Bielecki K. Roux-en-yor ‘uncut’ Roux procedure? Relation of intestinal migrating motor complex recovery to the preservation of the network of interstitial cells of Cajal in pigs. Exp Physiol. 2007;92:399–408. doi: 10.1113/expphysiol.2006.035253. [DOI] [PubMed] [Google Scholar]
- 13.Tu B.N., Kelly K.A. Elimination of the Roux stasis using a new type of “Uncut Roux” Limb. Am J Surg. 1995;170:381–386. doi: 10.1016/S0002-9610(05)80011-X. [DOI] [PubMed] [Google Scholar]