Uncut Roux Procedure after Total Gastrectomy

Cho, Moo Sik; Song, Ok Pyung; Lee, Dong Keun; Lee, Moon Soo; Baek, Moo Joon

Abstract

The Roux-en-Y esophagojejunostomy is one of the most common means of reconstructive surgery after a total gastrectomy. While these Roux operations work well in the majority of patients, approximately 30% of individuals undergoing them develop the so-called Roux stasis syndrome, consisting of chronic abdominal pain, nausea, vomiting, and postprandial bloating. The Roux stasis syndrome is thought to result from the jejunal transsection performed during the construction of a conventional Roux limb. The aim of this study was to review a new type of uncut Roux procedure, in which staple lines and loop ligation maintain myoneural continuity and prevent the Roux stasis syndrome between the proximal jejunum and the Roux limb. At the same time, a jejunojejunostomy provides distal diversion of pancreaticobiliary secretions. The postoperative courses of 23 cases of the uncut Roux procedure with staples after a total gastrectomy were compared with those of 18 cases of afferent proximal loop ligation with hand-sewn sutures, the procedures having been performed between May 1995 and January 1997. Passage of contrast media through the ligated afferent jejunal loop was identified in 34.8% of cases and occluded staple lines was identified in 38.9% of cases. It was found that the uncut Roux procedure prevents the Roux stasis syndrome and that the current technique has a high incidence of dehiscence of the staple lines and the loop ligation with subsequent reflux esophagitis. Because of the results reported here, other techniques, which maintain enteric myoneural continuity to an uncut Roux limb while providing complete and permanent diversion of the alkaline secretions distally from the esophagus, need to be developed before this type of anatomic reconstruction can be recommended.