Role of vagal dysfunction in motility and transit disorders of jejunal roux limb after roux-en-Y gastrojejunostomy

Abstract

After a Roux-en-Y gastrojejunostomy patients frequently complain about abdominal pain, fullness, nausea and vomiting, ie, the Roux-en-Y syndrome. Stasis in the Roux limb due to disordered motility is known to be a cause of these complaints. The aim of the present study was to determine whether vagal denervation contributes to the development of motility disturbances and stasis in the Roux limb. Forty-seven patients with a Roux-en-Y gastrojejunostomy after partial gastrectomy were studied. A truncal vagotomy had been performed in 26 of these 47 patients. Transit through the Roux limb was evaluated by radionuclide studies, motility in the Roux limb was studied by manometry, and vagal function was tested by measuring the pancreatic polypeptide response to an insulin-induced hypoglycemia (PP test). On the basis of the PP test patients were classified as having (1) normal, (2) moderately impaired, and (3) severely impaired vagal function. The PP test showed that two of the 26 patients subjected to vagotomy had a moderately impaired vagal function, the other 24 all had a severely impaired vagal function. In the patients not subjected to a vagotomy, vagal function was disturbed in 11 of the 21 patients. Motility disturbances were not observed more frequently in patients with either moderately or severely impaired vagal function than in patients with normal vagal function. Stasis in the Roux limb was seen even more frequently in patients with a normal vagal function than in patients with a severely impaired vagal function.(ABSTRACT TRUNCATED AT 250 WORDS)

Down-regulation of ghrelin receptors in the small intestine delays small intestinal transit in vagotomized rats

“…When the vagal nerve is injured, the delay in gastrointestinal transit increases (29)(30)(31). This delay in small intestinal transit might be caused by both central and peripheral mechanisms.…”

Gastrectomy in the Rat Using Two Modifications of Esophagojejunal Anastomosis

“…Intestinoesophageal reflux is most probably responsible for the inflammatory changes (see above). Motor disturbances in the Roux loop may promote reflux [31][32][33]. In rats with forestomach-saving GX the inflammatory lesions in the esophagus were minimal, and weight gain increased [12].…”

Dénutrition et carences à long terme après chirurgie œsogastrique

“…Cette stase peut se compliquer d'un bézoard dans 10 à 25 % des cas et compromettre sévèrement les ingesta [28]. À noter que le dysfonctionnement moteur de l'anse jéjunale montée est indépendant de la réalisation ou non d'une vagotomie [29].…”