Motility in the Roux‐Y limb after distal gastrectomy: relation to the length of the limb and the afferent duodenojejunal segment – an experimental study

Abstract

Following gastrectomy, the longer is a Roux-Y limb constructed to restore digestive continuity the higher the frequency of postoperative symptoms. The aim of this experimental study was to test how the level of the jejunal transection and the length of the Roux limb affect the motility of the constructed limb and in particular the onset and the propagation of activity fronts (AFs). Three months after a distal Roux-en-Y gastrectomy, electromyographic tracings were recorded in six groups of rats grouped according to the level of the transection (20 or 40 cm from the pylorus) and the length of the limb (10, 20 or 30 cm). Animals in which a simple laparotomy or laparotomy + jejunal transection was performed, served as controls. During the interdigestive period, all animals had AFs in the limb which were independent from those recorded in the duodenum. In the limb, the mean time interval between two AFs was shorter (P < 0.01) and more irregular than in controls. An increase in limb length was associated with a lower incidence of completely propagated AFs (P < 0.05) and a higher incidence of irregularly propagated AFs (P < 0.01). When propagation of the AFs was analysed both in the limb and in the jejunum distal to the anastomosis, propagation abnormalities were more frequent. Below the gastrojejunal anastomosis, for an intestinal length of either 20 or 30 cm, the frequency of abnormal AFs was not different when this length was either only a limb or a limb with the 10 cm of distal jejunum below the jejuno-jejunal anastomosis. Interruption of AFs by a meal was irregular in the limb and more rarely observed in the 30-cm than in 10-cm limbs (P < 0.05). Interruption of AFs was shorter than in controls (P < 0.01). In the duodenum and the jejunum proximal to the limb, the interval between AFs was higher than in controls and in the Roux-Y limbs (P < 0.001). Intraluminal concentrations of bacterial strains were not different in the different types of limb while lactobacillus concentrations and pooled concentrations of bacteria were higher than in controls (P < 0.05). No relationship was found between the incidence of myoelectric abnormalities and intraluminal bacterial concentrations. Increasing the length of a Roux-Y limb resulted in more frequent disturbances in AFs in the limb but had no significant consequence on the overall rate of abnormal AFs in the jejunum distal to the transection. Motor response to food intake was also reduced. Motor changes were not related to intraluminal bacterial concentrations.

A mechanistic pharmacokinetic model to assess modified oral drug bioavailability post bariatric surgery in morbidly obese patients: interplay between CYP3A gut wall metabolism, permeability and dissolution

“…In ten patients subject to Roux‐en‐Y with a total gastrectomy (cancer being the main indication), a mean small intestinal transit for solids of 293 ± 37 min was observed as compared with 187 ± 37 min in five controls ( P < 0.02), thus suggesting the small intestinal transit to be increased post RYGB [50] . Animal models of RYGB surgery suggested a similar impact of surgery as that observed in man, with disturbed small intestinal motility reported in rat and dog [54–56] …”

“…[50] Animal models of RYGB surgery suggested a similar impact of surgery as that observed in man, with disturbed small intestinal motility reported in rat and dog. [54][55][56] Two scenarios were created with regards to small intestinal transit time. In the first scenario the transit time was assumed [40][41][42][43] 200…”

The effects of Roux-en-Y limb length on gastric emptying and enterogastric reflux in rats

“…They employed a sequential scintigraphic HIDA Tc 99m research that demonstrated the absence of biliary reflux in the stomach remnant 12 . Le Blanc-Louvry et al 13 , reported that it is necessary to compare a short Roux limb that presents only a mild motor impairment, but allows that the enterobiliopancreatic juice flows back into the stomach, to a long Roux limb with significant motor impairment, but protects the stomach from the reflux.…”

Retrocolic Roux‐en‐Y anastomosis for total laparoscopic distal gastrectomy: Fix‐the‐remnant‐first technique

“…An additional issue to consider is liquid stasis in the gastric remnant after Roux‐en‐Y reconstruction for distal gastrectomy . We performed gastrojejunostomy for functional end‐to‐end anastomosis to create a straight entry to the Roux‐en‐Y limb and to avoid making an angle or a stricture just after the anastomosis.…”